HOW TO FILL OUT AN AFFIDAVIT FOR COLLECTION OF SMALL ESTATE
Print the decedent’s name on the line marked:
“IN THE MATTER OF THE ESTATE OF___________________________, Deceased”
Print your name on the first line, and any additional person(s) who will be signing on the lines after
your name, located under the centered title of Affidavit for Collection, etc.
Write the decedent’s name again on the line located after “for the purpose of dispensing with
administration of the estate of _________________________”
ITEM NO. 1:
The decedent’s information; indicate the following information for the lines provided:
A. Name of deceased person
B. Age of deceased person upon death
C. Address of residency
D. County of residency
E. Address at death (address of home, address of nursing home, address of hospital)
F. Month, day and year of death
ITEM NO. 5:
The decedent’s property information; indicate the following information along with the approximate
value of item, and the name of the person(s) that is currently possessing the property:
A. Checking account #’s, balance, bank name, name on account
B. Savings account #’s, balance, bank name, name on account
C. Vehicle descriptions (make, model, year, and VIN #).
D. Household Items
E. Stock & Bonds (Certificate/Account #’s, # of shares, and Name of Corporation)
F. Life insurance policies (policy #, insurance company, value of policy, beneficiary)
G. Mineral/gas royalties/rights (exact location, value, who has possession)
H. Homestead (exact location/address, value of property, name on deed)
**** Value of Homestead does not count toward $100,000.00 limit of estate****
ITEM NO. 6:
Information of person(s) lawfully entitled to receive property of the decedent. List the following:
A. Include yourself and anyone else who may be entitled to any property of the
decedent, including surviving spouse, heirs or devisees of the decedent’s will if the
decedent had a will written prior to death.
Your name and requested information, and any other person(s) that are listed in the first opening paragraph
on the first page. All persons listed on the first page must sign (on line marked “Affiant”) and date the
document in front of a notary public.
Bring the completed document to the Circuit Clerk’s office to be filed. The filing fee for an Affidavit for
Collection of Small Estate is $25.00, plus $5.00 for each certified copy requested. If you only need one
certified copy, the total cost is $30.00. If you prefer, you may mail your completed Affidavit along with
a check or money order in the appropriate amount to:
Circuit Clerk, Attn: Probate Division, PO Box 1179, Fort Smith, AR 72902. Be sure to include a self-
addressed, stamped envelope for prompt return.
If real property is involved (i.e. Homestead) it is your responsibility to have a “notice of probate”
published in the Times Record and to file a proof of publication with the Clerk’s office.