SMALL ESTATE AFFIDAVIT

I certify that all of the following statements are true regarding the Estate of [DECEDENT NAME]:

1. THE DECEDENT. Decedent, [DECEDENT NAME], died on [MM/DD/YYYY] in the County of [COUNTY], in the State of [STATE]. A copy of the decedent’s death certificate will be submitted along with this affidavit.

2. THE AFFIANT. My name is [AFFIANT NAME]. I reside at [AFFIANT ADDRESS]. I am either an heir of the decedent, and the decedent left no will, or I am a named devisee of the decedent in the decedent’s will.

3. ESTATE VALUE. The value of the assets of the decedent’s estate exceeds the estate’s known liabilities. The value of the decedent’s estate does not exceed the monetary limit imposed by the State of [DECEDENT STATE].

4. DAYS SINCE DEATH. More than [#] days have passed since the decedent’s death. There is no pending administration of the decedent’s estate. There is no reasonable expectation that probate of the decedent’s estate will soon commence.

5. HEIRS. All heirs or devisees will be notified of this affidavit within 30 days of filing. The heirs or devisees of the decedent are listed as follows:

Heir: [HEIR NAME]
Address: [HEIR ADDRESS]
Relation: [RELATION TO DECEDENT]
Phone: [PHONE NUMBER]

Heir: [HEIR NAME]
Address: [HEIR ADDRESS]
Relation: [RELATION TO DECEDENT]
Phone: [PHONE NUMBER]

(Add additional Heirs or Devisees as necessary)

6. ASSETS. All assets of the decedent’s estate (whether real property or personal property, whether community property or separate property) and the value of such assets are listed below:

DESCRIPTION                    VALUE

[DESCRIPTION]                [VALUE ($)]
[DESCRIPTION]                [VALUE ($)]
[DESCRIPTION]                [VALUE ($)]

(Add additional Assets as necessary)

7. LIABILITIES. All liabilities and debts of the decedent’s estate and what the estate owes each creditor are listed below:

DESCRIPTION                    VALUE

[DESCRIPTION]                [VALUE ($)]
[DESCRIPTION]                [VALUE ($)]
[DESCRIPTION]                [VALUE ($)]

(Add additional Liabilities or Debts as necessary)

8. PROPERTY TO BE TRANSFERRED. The following heirs or devisees are entitled to the following property:

HEIR NAME                        PROPERTY

[FULL NAME]                     [PROPERTY DESCRIPTION]
[FULL NAME]                     [PROPERTY DESCRIPTION]
[FULL NAME]                     [PROPERTY DESCRIPTION]

(Add additional Heirs or Devisees as necessary)

9. STATE LAW. This document is governed under the laws in the State of [STATE NAME].

10. EXECUTION.

Affiant (Preparer) Signature: _________________________ Date: [MM/DD/YYYY]

Subscribed and sworn to before me on [MM/DD/YYYY], [COUNTY AND STATE].
My commission expires: [MM/DD/YYYY] Signature: _________________________
Notary public, [COUNTY AND STATE (WHERE COMMISSIONED)].