Small Estate Affidavit: Skip Probate (Free Template)

STATE OF [STATE]                    )
                                    )  ss.
COUNTY OF [COUNTY]                  )


                       SMALL ESTATE AFFIDAVIT
              (For Collection of Personal Property
                of Decedent Without Probate)


    BEFORE ME, the undersigned authority, on this day personally
appeared [Affiant Full Legal Name] (the "Affiant"), who, being by
me first duly sworn upon oath, deposed and stated as follows:


    1.  DECEDENT. [Decedent Full Legal Name] (the "Decedent") died
        on [Date of Death] at [City, State of Death]. The Decedent
        was at the time of death a resident of [County, State of
        Residence], and the Decedent's mailing address at death
        was [Address, City, State, ZIP]. A certified copy of the
        Decedent's death certificate is attached hereto as
        Exhibit A and incorporated by reference.

    2.  AFFIANT AND CAPACITY. Affiant's full legal name is
        [Affiant Full Legal Name]. Affiant resides at [Affiant
        Street Address, City, State, ZIP]. Affiant is [Affiant's
        relationship to the Decedent, e.g., surviving spouse, adult
        child, parent, sibling, or named distributee under the
        Decedent's Last Will and Testament dated _______________].
        Affiant is a person entitled to the Decedent's property
        described herein under (a) the laws of intestate succession
        of the State of [Controlling State] OR (b) the Decedent's
        Last Will and Testament admitted to or eligible for
        admission to probate, a true and correct copy of which is
        attached as Exhibit B (delete (a) or (b) as applicable).

    3.  STATUTORY ELIGIBILITY. The Decedent's estate qualifies for
        collection by small estate affidavit under [cite controlling
        statute, e.g., Cal. Probate Code Sections 13100-13117; Tex.
        Estates Code Chapter 205; 755 ILCS 5/25-1; Fla. Stat.
        Chapter 735; Ind. Code Section 29-1-8-1; Wash. Rev. Code
        Section 11.62.010; Va. Code Section 64.2-601; Mo. Rev.
        Stat. Section 473.097]. Affiant affirms each of the
        following under penalty of perjury:

        (a)  At least [State Waiting Period, e.g., 40 days for
             California, 30 days for Texas and Missouri, 45 days
             for Indiana, 60 days for Virginia] have elapsed since
             the Decedent's date of death.

        (b)  No proceeding is now being or has been conducted in
             any jurisdiction for administration of the Decedent's
             estate, and no application or petition for the
             appointment of a personal representative is pending or
             has been granted in any jurisdiction.

        (c)  The current gross fair market value of all of the
             Decedent's property subject to administration in the
             State of [Controlling State], wherever located,
             excluding the property described in [the controlling
             exclusion subsection, e.g., Cal. Probate Code Section
             13050], does not exceed $[State Threshold].

        (d)  All known unsecured debts of the Decedent, including
             funeral and last-illness expenses, will be paid from
             the property collected by Affiant under this
             Affidavit before any distribution is made to other
             successors.

        (e)  No other person has a right superior to that of the
             Affiant to the Decedent's property described in
             Paragraph 5 below.

        (f)  If there are other persons entitled to the Decedent's
             property described herein, each such person has either
             (i) consented in writing to Affiant's collection of
             the property on their behalf (such consents are
             attached as Exhibit C) or (ii) has been given written
             notice of this Affidavit and the proposed distribution
             not less than ten (10) days before this Affidavit is
             presented for collection.

        (g)  Affiant has made a diligent and good-faith inquiry
             into the existence of any other property, debts,
             heirs, devisees, and creditors of the Decedent and
             has disclosed all such matters in this Affidavit.

        (h)  Affiant is acting on behalf of all persons entitled
             to the Decedent's property and will distribute the
             property collected hereunder to those persons in the
             shares to which they are entitled by law or by the
             Decedent's Will.

        (i)  Affiant understands and agrees that any holder of the
             Decedent's property who pays, delivers, transfers, or
             issues the property to Affiant in good-faith reliance
             on this Affidavit is, to the fullest extent permitted
             by law, released and discharged from all further
             liability with respect to the property so delivered.

    4.  HEIRS AND DISTRIBUTEES. The persons entitled to receive
        the Decedent's property described in Paragraph 5, their
        respective addresses, their relationships to the Decedent,
        and their respective shares, are as follows:

        Name:          [Full Legal Name]
        Address:       [Street, City, State, ZIP]
        Relationship:  [Relationship to Decedent]
        Share:         [Fractional share or specific bequest]

        Name:          [Full Legal Name]
        Address:       [Street, City, State, ZIP]
        Relationship:  [Relationship to Decedent]
        Share:         [Fractional share or specific bequest]

        [Repeat for each heir, devisee, or distributee. Attach
        additional pages as Exhibit D if necessary.]

    5.  PROPERTY SUBJECT TO COLLECTION. The personal property of
        the Decedent that Affiant requests be paid, delivered,
        transferred, or issued to Affiant under this Affidavit is
        identified as follows. Each item shall be released by the
        named holder to Affiant upon presentation of this
        Affidavit and Affiant's photo identification:

        (a)  BANK AND CREDIT-UNION ACCOUNTS:
             Holder:        [Bank Name and Branch]
             Account No.:   [Last four digits]
             Account Type:  [Checking / Savings / Money Market]
             Balance:       $[Approximate balance at date of death]

        (b)  BROKERAGE, SECURITIES, AND RETIREMENT ACCOUNTS:
             Holder:        [Brokerage / Plan Sponsor]
             Account No.:   [Last four digits]
             Holdings:      [Cash, equities, mutual funds, IRA, 401k]
             Value:         $[Approximate value at date of death]

        (c)  WAGES, SALARY, COMMISSIONS, AND FINAL PAY:
             Employer:      [Employer Name]
             Amount:        $[Final wages owed]

        (d)  VEHICLES (cars, trucks, motorcycles, boats, RVs):
             Year/Make/Model: [Year, Make, Model]
             VIN:             [Full Vehicle Identification Number]
             Title No.:       [State Title Number]
             Value:           $[Fair market value]

        (e)  TANGIBLE PERSONAL PROPERTY:
             Description:   [Furnishings, jewelry, collections,
                             firearms, household goods]
             Value:         $[Aggregate fair market value]

        (f)  REFUNDS, RECEIVABLES, AND OTHER INTANGIBLES:
             Description:   [Insurance refunds, security deposits,
                             tax refunds, accounts receivable]
             Value:         $[Approximate value]

        TOTAL FAIR MARKET VALUE OF PROPERTY:  $[Total]

    6.  REAL PROPERTY (delete this paragraph entirely if the
        controlling statute does not authorize the collection of
        real property by small estate affidavit; California uses a
        separate Probate Code Section 13200 affidavit for real
        property worth $61,500 or less; Texas uses a separate
        affidavit of heirship for non-homestead realty under
        Estates Code Chapter 203; many states permit no
        real-property collection by SEA at all):

        Legal Description:           [Legal description from the
                                      recorded deed]
        County and State of Record:  [County, State]
        Recording Information:       [Book/Page or Instrument No.]
        Estimated Fair Market Value: $[Value]

    7.  KNOWN DEBTS AND PRIORITY CLAIMS. The following are all of
        the Decedent's known debts, in the order of statutory
        priority, that Affiant will pay from the property
        collected hereunder before any distribution to successors:

        (a)  Funeral and burial expenses:                   $[___]
        (b)  Last-illness medical and hospital expenses:    $[___]
        (c)  Federal and state taxes due:                   $[___]
        (d)  Secured debts on collected property:           $[___]
        (e)  Other unsecured debts (list and amount):       $[___]

        TOTAL KNOWN DEBTS:                                  $[___]

    8.  DEMAND AND DELIVERY. Affiant requests that each holder
        identified in Paragraph 5 pay, deliver, transfer, or issue
        the property described to Affiant immediately upon
        presentation of this Affidavit, together with a certified
        copy of the Decedent's death certificate (Exhibit A) and
        Affiant's photo identification. Each such holder is
        directed to a copy of the controlling statute cited in
        Paragraph 3 and is reminded of the holder's statutory
        obligation to release the property without further legal
        process and the holder's statutory discharge from further
        liability for doing so.


    FURTHER AFFIANT SAYETH NAUGHT.


    I declare under penalty of perjury under the laws of the State
of [Controlling State] that the foregoing is true and correct.


    Executed on this _____ day of _______________, 20____, at
[City, State of Execution].


                                    _______________________________________
                                    [Affiant Full Legal Name], Affiant


================================================================================
                              NOTARY ACKNOWLEDGMENT
                                  (JURAT FORM)
================================================================================

STATE OF [STATE]                    )
                                    )  ss.
COUNTY OF [COUNTY]                  )

    Subscribed and sworn to (or affirmed) before me on this _____
day of _______________, 20____, by [Affiant Full Legal Name],
proved to me on the basis of satisfactory evidence to be the
person who appeared before me and who, having been duly sworn,
acknowledged that he or she executed the foregoing Affidavit for
the purposes therein stated.


                                    _______________________________________
                                    Notary Public, State of [State]

                                    Printed Name: _________________________

                                    Commission No.: _______________________

                                    My Commission Expires: ________________

                                    [NOTARY SEAL / STAMP]


================================================================================
                       ALTERNATIVE: 28 U.S.C. SECTION 1746
                            UNSWORN DECLARATION
              (Use in lieu of notary jurat for federal cross-
              state collection from holders that accept the
              federal unsworn-declaration form)
================================================================================

    I declare under penalty of perjury under the laws of the
United States of America that the foregoing is true and correct.

    Executed on _______________, 20____, at [City, State].


                                    _______________________________________
                                    [Affiant Full Legal Name], Declarant


================================================================================
                       TEXAS-PATTERN WITNESS BLOCK
              (Required by Tex. Estates Code Section 205.002
                only when filing under Chapter 205. Delete
                this block in all other states.)
================================================================================

    The undersigned, being two disinterested witnesses, neither of
whom is named as an heir or distributee herein and neither of
whom claims any interest in the Decedent's estate, hereby state
under oath that we have read the foregoing Small Estate Affidavit
and to the best of our knowledge and belief the statements
contained therein concerning the family history, marital history,
and identity of the Decedent's heirs are true and correct.


    _______________________________________
    Disinterested Witness 1, Printed Name and Signature

    Address: ______________________________

    _______________________________________
    Disinterested Witness 2, Printed Name and Signature

    Address: ______________________________


    Subscribed and sworn to before me by both of the above-named
disinterested witnesses on this _____ day of _______________,
20____.

                                    _______________________________________
                                    Notary Public, State of [State]

                                    [NOTARY SEAL / STAMP]


================================================================================
                              REQUIRED ATTACHMENTS
================================================================================

    Exhibit A:  Certified copy of the Decedent's death certificate
    Exhibit B:  Original or certified copy of the Decedent's Last
                Will and Testament (if any)
    Exhibit C:  Written consents of any other entitled successors
                (if applicable)
    Exhibit D:  Continuation pages for the heir / distributee
                schedule (if needed)
    Exhibit E:  Inventory and appraisal of personal property with
                supporting valuations
    Exhibit F:  Receipts evidencing payment of funeral expenses
    Exhibit G:  Photocopy of the Affiant's government-issued photo
                identification