Affiant Identification and Capacity
Affiant Full Name: [[Affiant Full Name]]
Affiant Relationship to Decedent: [[Affiant Relationship to Decedent]]
Affiant Address: [[Affiant Street Address]]
Affiant City, State, ZIP Code: [[Affiant City, State, ZIP]]
Affiant Telephone Number: [[Affiant Telephone]]
Affiant Email Address: [[Affiant Email]]
The Affiant is an heir or other person entitled under the laws of intestate succession or the Decedent's will to the property described herein. The Affiant has legal authority to collect such property on behalf of the estate or the entitled persons.
Decedent Identification
Decedent Full Legal Name: [[Decedent Full Name]]
Decedent's Date of Death: [[Date of Death]]
Decedent's Place of Death: [[Place of Death if known]]
Decedent's Last Known Address: [[Decedent Last Known Street Address]], [[Decedent City]], [[State]] [[Decedent ZIP]]
Decedent's Date of Birth (optional): [[Decedent Date of Birth]]
Social Security Number of Decedent (last four digits only if required): [[Last Four SSN]]
A certified copy of the Decedent's death certificate issued by the appropriate vital records authority is attached hereto or will be provided upon request.
Estate Qualification Under Small Estate Statute
The Affiant represents and warrants the following:
- The gross value of the Decedent's probate assets in the State of [[State]] (real and personal property subject to probate) does not exceed the applicable small estate monetary threshold as of the date of death under [[State]] statutes.
- The statutory waiting period following the Decedent's death has elapsed. For reference, many jurisdictions require thirty (30) days; the State of California requires forty (40) days; the Affiant confirms that [[Waiting Period Days]] days have passed since [[Date of Death]].
- No petition for formal probate or letters testamentary or of administration has been filed in any court having jurisdiction, and no such proceeding is pending or contemplated.
- The Decedent died leaving no will requiring formal probate, or if a will exists, the will has been reviewed and all persons entitled consent to the use of this small estate procedure, or the will does not necessitate full administration.
- All heirs, devisees, or other persons entitled to distribution have been identified and either join in this Affidavit or have provided written consent, or their interests are represented herein.
- There are no known creditors whose claims would require formal probate administration or whose claims exceed the value of assets available after exempt property.
List of Probate Assets
The following is a complete list of the Decedent's probate assets known to the Affiant, together with approximate fair market values as of the date of death. Non-probate assets such as those passing by beneficiary designation, joint ownership with right of survivorship, or trust are excluded from this list.
- Bank accounts and cash equivalents: [[Bank or Credit Union Name]], Account Number ending in [[Last Four Digits]], approximate value [[Dollar Amount of Bank Assets]].
- Stocks, bonds, mutual funds, and brokerage accounts: [[Brokerage or Investment Firm]], Account or Certificate details [[Description of Securities]], approximate value [[Dollar Amount of Investment Assets]].
- Vehicles: [[Year, Make, Model, VIN of Vehicle]], approximate value [[Dollar Amount for Vehicle]].
- Personal property, household goods, and furnishings: [[Description of Tangible Personal Property]], approximate aggregate value [[Dollar Amount for Personal Property]].
- Other probate assets: [[Description of Additional Assets such as uncashed checks, refunds, or miscellaneous property]], approximate value [[Dollar Amount for Other Assets]].
Total Approximate Value of Listed Probate Assets: [[Total Value of Probate Assets]]
The Affiant affirms that this list is true and complete to the best of the Affiant's knowledge. Any subsequently discovered assets of similar character shall be subject to the same distribution.
Heirs, Devisees, and Entitlement
The following persons are the heirs at law or devisees entitled to the assets of the Decedent's estate:
- [[Full Name of Heir 1]], relationship [[Relationship e.g. spouse / child / sibling]], entitled share [[Percentage or Description of Share]], address [[Heir 1 Address]].
- [[Full Name of Heir 2]], relationship [[Relationship]], entitled share [[Percentage or Description of Share]], address [[Heir 2 Address]].
- [[Full Name of Heir 3]], relationship [[Relationship]], entitled share [[Percentage or Description of Share]], address [[Heir 3 Address]].
If any named individual predeceased the Decedent, their share shall pass according to the laws of intestate succession of the State of [[State]] or the terms of the Decedent's will.
The Affiant represents that there are no other persons known to the Affiant who have a superior or equal claim to the assets.
Statement Regarding No Pending Probate and Consents
No probate or administration is pending. The Affiant has made reasonable inquiry and to the best of the Affiant's knowledge:
- No application for appointment of a personal representative is pending in any court.
- No other person has been appointed or is acting as executor, administrator, or personal representative.
- All known heirs and persons entitled have either signed this Affidavit, provided separate written consent, or are accounted for herein.
- The Affiant will distribute the collected assets in accordance with the Decedent's will (if any) or the laws of intestacy of [[State]].
Property to Be Collected or Transferred
The Affiant requests that any bank, brokerage, transfer agent, title company, insurance company, governmental agency, or other holder of the listed assets release, transfer, pay, or re-register such assets to the Affiant or the designated distributee(s) upon presentation of this Affidavit and any supporting documentation required by the holder.
Specific instructions for transfer or payment:
- Pay or transfer the assets to: [[Name(s) of Person(s) or Estate to Receive Assets]]
- At the following address or account: [[Recipient Address or Account Details]]
- Any required tax identification or forms will be provided separately.
Additional Representations and Warranties
The Affiant further represents and affirms as follows:
- The Affiant has conducted a diligent search for all assets of the Decedent and has disclosed all probate assets of which the Affiant has knowledge or reasonable belief.
- The Affiant has no knowledge of any pending claims, lawsuits, or disputes that would affect the distribution of the listed assets other than those disclosed to the holders if required.
- The Affiant will use the assets collected solely for the benefit of the estate and the persons entitled thereto, and will account to any court or interested party as required by law.
- If the Affiant later learns that the estate value exceeded the small estate threshold or that formal probate is required, the Affiant will promptly notify all affected parties and take appropriate steps to open formal administration.
- The Affiant understands that making a false statement in this Affidavit may constitute perjury or other criminal offense under the laws of [[State]] and the United States.
Governing Law
This Affidavit shall be governed by and construed in accordance with the laws of the State of [[State]], without regard to its conflict of laws principles. The Affiant submits to the jurisdiction of the courts of [[State]] for any matters arising out of or relating to this Affidavit or the collection of assets hereunder.
Indemnification and Reliance
The Affiant agrees to indemnify and hold harmless any person, institution, or entity that relies in good faith upon this Affidavit and transfers assets in accordance herewith, from and against any and all claims, losses, damages, costs, and expenses arising from any inaccuracy in the statements made herein or from any later-discovered claims of additional heirs or creditors, to the fullest extent permitted by law.
Any person or institution may rely upon a copy of this Affidavit as if it were an original.
Signature of Affiant
IN WITNESS WHEREOF, the Affiant has executed this Small Estate Affidavit on the date set forth below.
Signature of Affiant: ____________________________________________
Printed Name of Affiant: [[Affiant Full Name]]
Date Signed: [[Date Affidavit Signed]]
Notary Jurat
State of [[State]]
County of [[County]]
On this ___ day of ______________, 20___, before me personally appeared [[Affiant Full Name]], proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that they executed the same for the purposes therein stated.
I certify under PENALTY OF PERJURY under the laws of the State of [[State]] that the foregoing paragraph is true and correct.
WITNESS my hand and official seal.
Notary Public Signature: ____________________________________________
Printed Name of Notary Public: ____________________________________________
My Commission Expires: ____________________________________________
(Seal)
Schedule A - Detailed Asset Schedule (Optional Attachment)
Use this schedule if additional space is needed. Attach extra pages as necessary and reference them.
| Asset Type | Institution / Description | Account / ID | Approximate Value |
|------------|---------------------------|--------------|-------------------|
| Bank/Cash | [[Institution Name 1]] | [[Acct #]] | [[Value 1]] |
| Securities | [[Institution Name 2]] | [[Acct #]] | [[Value 2]] |
| Vehicle | [[Year Make Model VIN]] | [[VIN]] | [[Value 3]] |
| Other | [[Description]] | [[ID]] | [[Value 4]] |
Disclaimer
This Small Estate Affidavit is a template intended to assist in the collection of small estates without formal probate. It is provided for informational and template purposes only. Laws governing small estate procedures, asset thresholds, waiting periods, required disclosures, and forms vary significantly by state and may change. The Affiant must verify all information, thresholds, and procedures with the statutes of the State of [[State]] and any applicable local rules or court requirements in effect as of the date of use. Certain assets (real property, certain vehicles, or claims) may require additional documentation, court orders, or separate procedures even in small estates. This document does not constitute legal advice. The user should consult a qualified attorney licensed in the relevant jurisdiction before relying on or submitting this form. Figures, requirements, and procedures must be confirmed against primary legal sources. Information current as of June 2026.
End of Small Estate Affidavit
