Illinois Small Estate Affidavit Form

Illinois Small Estate Affidavit is a legal document that defines the distribution of assets and estates of a deceased person. Filing the affidavit is necessary when the descendent dies on or after 9/4/1991.

You can appoint an agent for service of process in Illinois or the Clerk of the Circuit Court acts as an agent for service of process. Enclose a copy of the death certificate and/or will along with the affidavit. The Section 32.2 of the Criminal Code Of 1961 has provisions for penalties for fraudulent statements made using the Small Estate Affidavit. Specify the distribution of the property/assets in section 11 as needed. Section 6 of the Small Estate Affidavit requires the input of the description of the descendant’s property/asset in detail. Read the Small Estate Affidavit completely before you proceed with filling it.

Begin by entering the legal name of the affiant followed by mentioning the post office address and residential address in the respective spaces. Fill the details like name, address, city, state, and zip code along with the telephone number in case you as affiant are out-of-state resident in the subsection C of the section 1. Type the name of the county of the Illinois state in the space provided to complete section 1.

Enter the legal name of the descendant in the space available in section 2 of the Small Estate Affidavit. Continue by typing the date of the death in section 3.

Section 4 requires the input of the address of the descendant when he/she passed away. This needs to be the immediate address at the death.

Section 6 holds immense importance in the Small Estate Affidavit as it seeks information about the gross value of the entire personal estate of the deceased person. Include the description of other properties/assets passed to any other party/ies under a will or intestacy. Use a separate line to list the details of each asset/ property.

In section 7, select choice A, if the funeral expenses of the deceased person are fully paid and no outstanding dues are there. Alternately, select choice B and fill in the details of the name, post office address, and amount of liability of funeral expenses for each accountable person in the following spaces. Use a separate line for each person’s details.

Section 9 subsection A requires the input of the name and relationship followed by the place of residence and age in case of minor child/ren that are surviving spouse, adult dependent child/ren and/or minor child/ren of the descendant. Compute the award allowable as per the directives in subsection B of section 9 and enter the amount in US dollar in the space provided for the same. Enter the amount of award allowable as per the guidelines of computation in case there is no surviving spouse in subsection C.

Illinois Small Estate Affidavit

Text version of this Form

———————– Page 1———————–

SMALL ESTATE AFFIDAVIT
[ to be used only when decedent died
on or after September 4, 1991.]

I, , 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:

Name_________________________________________

Address_______________________________________

City___________________________________________

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.

2. The decedent’s name is ___________________________________________________

3. The date of the decedent’s death was________________________, and I
have attached a copy of the death certificate hereto.

4. The decedent’s place of residence immediately before his death was_________
_______________________________________________________________________________________

5. 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.

6. 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.)

Page 1 of 4

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7. ( a ) All of the decedent’s funeral expenses have been paid, or

( b ) The amount of the decedent’s unpaid funeral expenses and the name and post
office address of each person entitled thereto are as follows:

Name and post office address Amount

(Strike either 7(a) or 7(b).)

8. There is no known unpaid claimant or contested claim against the decedent,
except as stated in paragraph 7.

9. ( a ) The names and places of residence of any surviving spouse, minor children and
adult dependent children* of the decedent are as follows:
Name and Place of Age of
Relationship Residence Minor Child

*(Note: An adult dependent child is one who is unable to maintain himself and is likely to
become a public charge.)

( b ) The award allowable to the surviving spouse of a decedent who was an Illinois
resident is $___________________ ($10,000, plus $5,000 multiplied by the number of minor
children and adult dependent children who resided with the surviving spouse at the time of
the decedent’s death. If any such child did not reside with the surviving spouse at the
time of the decent’s death, so indicate).

( c ) If there is no surviving spouse, the award allowable to minor children and
adult dependent children of a decedent who was an Illinois resident is $________________
($10,000, plus $5,000 multiplied by the number of minor children and adult dependent
children), to be divided among them in equal shares.

Page 2 of 4

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10. ( a ) The decedent left no will. The names, places of residence and relationship of
the decedent’s heirs, and the portion of the estate to which eash heir is entitled under
the law where decedent died intestate are as follows:

Name, relationship Age of Portion of
and place of residence Minor estate

(or)
( b ) The decedent left a will, which has been filed with the clerk of an
appropriate court. A certified copy of the will on file is attached. To the best of my
knowledge and belief the will on file is the decedent’s last will and was signed by the
decedent and the attesting witnesses as required by law and would be admissable to
probate. The names and places of residence of the legatees and the portion of the estate,
if any, to which each legatee is entitled are as follows:

Name, relationship Age of Portion of
and place of residence Minor estate

(Strike either 10(a) or 10(b).)
( c ) Affiant is unaware of any dispute or potential conflict as to heirship or
will of the decedent.

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11. The property described in paragraph 6 of this affidavit would be distributed
as follows:
Specific sum or property
Name to be distributed

The foregoing statement is made under the penalties of perjury.*

_______________________________________________
Signature of affiant

*(Note: A FRAUDULENT STATEMENT MADE UNDER THE PENALTIES OF PERJURY IS PERJURY, AS DEFINED

IN THE SECTION 32.2 OF THE CRIMINAL CODE OF 1961.)

Name________________________________________________________________________________________

Business Address____________________________________________________________________________

City, State, Zip Code_________________________________________________________________________

Telephone number___( )

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