Small Estate Affidavit

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[ to be used only when decedent died
on or after September 4, 1991.]
, on oath state:
(name of affiant)
1. ( a ) My post office address is:__________________________________________________
( b ) My residence address is:___________________________________________________
( c ) I understand that, if I am an out-of-state resident, I submit myself to the
jurisdiction of Illinois courts for all matters related to the preparation and use of this
affidavit. My agent for service of process in Illinois is:
Telephone (if any)______________________________
I understand that if no person is named above as my agent for service or, if for any
reason, service on the named person cannot be effectuated, the Clerk of the Circuit Court
of ______________________________ (county)(Judicial Circuit), Illinois is recognized
by Illinois law as my agent for service of process.
The decedent's name is ___________________________________________________
The date of the decedent's death was________________________, and I
have attached a copy of the death certificate hereto.
The decedent's place of residence immediately before his death was_________
No letters of office are now outstanding on the decedent's estate and no
petition for letters is contemplated or pending in Illinois or in any other jurisdiction,
to my knowledge.
The gross value of the decedent's entire personal estate, including the value
of all property passing to any party either by intestacy or under a will, does not exceed
$100,000. (here, list each asset, e.g. cash, stock and its fair market value.)
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