Fillable Form updated September 1, 2017: Small Estate Affidavit (Texas Secretary of State)

Fill Online, Printable, Fillable, Blank Form updated September 1, 2017: Small Estate Affidavit (Texas Secretary of State) Form

Use Fill to complete blank online TEXAS SECRETARY OF STATE pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Form updated September 1, 2017: Small Estate Affidavit (Texas Secretary of State)

On average this form takes 43 minutes to complete

The Form updated September 1, 2017: Small Estate Affidavit (Texas Secretary of State) form is 9 pages long and contains:

  • 0 signatures
  • 15 check-boxes
  • 163 other fields

Country of origin: US
File type: PDF

Use our library of forms to quickly fill and sign your Texas Secretary of State forms online.

BROWSE TEXAS SECRETARY OF STATE FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Form updated September 1, 2017
Cause NO. _________________
Estate of
______________________________,
Deceased
§
§
§
§
§
County Court
of
Bastrop County, Texas
Small Estate Affidavit
On the dates indicated below, all of the Distributees of this estate and two disinterested witnesses
personally appeared and, on their oath, did swear or affirm to the accuracy of the following facts, pursuant
to Chapter 205 of the Texas Estates Code:
A. Decedent, ____________________________________________, died on the ________ day of
_______________________, 20______ in __________________ County, Texas. A copy of
Decedent’s death certificate will be filed in this cause number at the time this Affidavit is filed.
B. More than 30 days have elapsed since Decedent’s death.
C. Decedent was a resident of and domiciled in _________________ County, Texas, at the time of
Decedent’s death.
D. Decedent died without a will.
E. No administration is pending or has been granted in Decedent’s estate and none appears necessary.
F. The value of the entire assets of the estate of Decedent, not including homestead and exempt
property, does not exceed $75,000.00.
G. The value of the entire assets of the estate of Decedent, not including homestead and exempt
property, exceeds the known liabilities.
H. Medicaid – check the accurate box:
The Decedent did not apply for and receive Medicaid benefits on or after March 1, 2005.
OR
Decedent did apply for and receive Medicaid benefits on or after March 1, 2005, and the Medicaid
Estate Recovery Program claim is listed as a liability in section “J” below.
OR
The Decedent did apply for and receive Medicaid benefits on or after March 1, 2005, but there is
no Medicaid claim against the estate. [If this box is checked, applicant(s) must either (1) file a
Medicaid Estate Recovery Program (MERP) certification that decedent’s estate is not subject to
a MERP claim or (2) include additional information proving that a MERP claim will not be
filed.]
I. All assets of the Decedent’s estate and their values are listed here.
NOTE: Community property is property acquired during marriage other than by gift or inheritance.
Separate property is property owned before marriage or acquired by gift or inheritance during marriage.
Description of Asset(s)
List with enough detail to identify exactly
what the asset is. For example, give bank
name and last four digits of an account
number; give life insurance company name;
give description of car plus VIN number; give
address & legal description of real property.
Value
Additional information
If decedent was married, indicate:
1. whether each asset was community or separate property, and
2. facts that explain why the asset was community or separate
If decedent was survived by a spouse, minor children, or unmarried adult
children who lived with decedent, the list of known estate assets must indicate
which assets applicant claims are exempt. See checklist for more information.
Use additional pages as necessary.
(Continue list as necessary. If list is continued on another page, please note.)
J. All liabilities/debts of the Decedent’s estate and their values are listed here. The affidavit must list
all of Decedent’s debts and other liabilities including all credit card balances, doctor and hospital bills,
utility bills, etc. – everything owed by Decedent or Decedent’s estate and not paid off.
If none, write “none.”
If funeral debts or attorney’s fees and expenses will be paid from estate assets, list them here.
Description of Liabilities / Debts: List with enough detail to identify the creditor & any account. Balance Due
(Continue list as necessary. If list is continued on another page, please note.)
If you did not list attorney’s fees as a liability above but one or more distributees have paid or will pay
attorney’s fees for this small estate affidavit, indicate the amount of those fees here: $________________.
Also indicate who has paid or will pay the fees: _______________________________________________.
K. The following facts regarding Decedent’s family history show who is entitled to what share of
Decedent’s estate, to the extent that the assets of Decedent’s estate, exclusive of homestead and
exempt property, exceed the liabilities of Decedent’s estate. [Put check marks in the appropriate
small boxes, and provide additional information as indicated.]
Family History #1: Marriage.
On the date of Decedent’s death, Decedent was a single person.
OR
On the date of Decedent’s death, Decedent was married to __________________________.
The date they were married: __________________________________.
Family History #2: Children.
Decedent had no children by birth or adoption, and Decedent did not take any children into
Decedent’s home to raise as a child. (Skip to Family History #4 if you check this box.)
OR
The following children were born to or adopted by Decedent. List all children, whether or not
the child is still alive and whether or not parental rights were later terminated. If parental rights
were terminated for any child, give details on separate page(s).
Child’s name Birth date, if known Name of child’s other parent
(Continue list as necessary. If list is continued on another page, please note.)
Family History #3: Children, part 2. Answer if Decedent had any children.
All of Decedent’s children, by birth or adoption, were alive when Decedent died. (If any heir
died after the Decedent, contact the Court Administrator before getting signatures on this form.)
OR
The following of Decedent’s children, by birth or adoption, died before the Decedent’s death
and were survived by children (or grandchildren or great-grandchildren):
Name of deceased child (followed by
the name of the deceased child’s
other parent in parentheses)
Date child
died
Names of all children of the deceased child
(if any of these children died before Decedent, use a separate page to
give date of death, plus names & birth dates of all grandchildren)
(Continue list as necessary. If list is continued on another page, please note.)
AND/OR
The following of Decedent’s children, by birth or adoption, died before the Decedent’s death
and were not survived by any children, grandchildren, or great-grandchildren:
Name of deceased child Date child died
(Continue list as necessary. If list is continued on another page, please note.)
If Decedent was survived by any children, grandchildren, or great-grandchildren, you do
not need to answer Family History #4 about Parents or Family History #5 about Sisters
and Brothers. You may skip to “L” (following #5).
Family History #4: Parents.
The Decedent was survived by both parents, ______________________________ (mother)
and ______________________________ (father).
OR
Decedent was survived by only one parent, ______________________________.
Decedent’s other parent, ______________________________, died on ________________.
OR
Both of Decedent’s parents died before Decedent’s death.
Family History #5: Sisters and Brothers.
The following information about Decedent’s sisters and brothers is not needed if Decedent was
survived by both parents or by children, grandchildren, or great-grandchildren.
The following are all of Decedent’s brothers and sisters who were alive on the date Decedent
died, including half-brothers and half-sisters who were born to either of Decedent’s parents.
If none, write “none.” If any of the following are now deceased, indicate date of death.
Name of brother or sister State whether full or half-sibling Birth date
(Continue list as necessary. If list is continued on another page, please note.)
AND
The following of Decedent’s brothers and sisters (including half-brothers and half-sisters who
were born to either of Decedent’s parents) died before Decedent’s death. If none, write
“none.”
Name of deceased brother or
sister (followed by the date of
death in parentheses)
Full or
half
sibling?
Names of all children of the deceased brother
or sister (nephews and nieces of Decedent)
that were alive on the date Decedent died
Birth dates of nieces
& nephews
(Continue list as necessary. If list is continued on another page, please note.)
Family History #6: Other.
Fill out a separate page (or pages) if Decedent was survived by none of the following: spouse,
child, grandchild, parent, brother, sister, half-brother, half-sister, niece, or nephew. If Decedent
was survived by none of the above, list all of the surviving relatives of Decedent on a separate page.
Specify Decedent’s family history with respect to each of the survivors, giving sufficient detail about
names, birth dates, death dates, and relationships to explain how each survivor is related to
Decedent.
EVERYONE MUST FILL OUT THE FOLLOWING CHART. Before filling
out the chart, see #13 & #15 and pages 4-6 of the Court’s Small Estate Affidavit Checklist.
L. Based on the family history given in this Affidavit, the following chart lists all of the Decedent’s
heirs at law, together with their fractional interests in Decedent’s estate:
For each Distributee, list:
1. Name
2. Address
3. Telephone number
4. Email address
Share of separate
personal property
(always fill out this
column)
Share of separate
real property
(always fill out this
column)
Share of decedent’s
community property
(fill out this column if
decedent was married)
(Continue list as necessary. If list is continued on another page, please note.)
Affidavits and signatures of all Distributee(s).
As needed, include other signature pages for additional distributees.
Every signature page for a distributee must include the box below:
We, as Distributees of the Decedent and as indicated by our signatures below, do solemnly swear or
affirm the following:
the foregoing Affidavit was completed by persons who have actual knowledge of the stated facts;
all of the facts stated in the foregoing Affidavit are true and complete; and
each of us has legal capacity.
We pray that this Affidavit be filed in the records of the Bastrop County Clerk; that the same be approved
by the Court; and that the Clerk issue certified copies of this Affidavit and the order approving it as
evidence of Distributees’ right to inherit the property of Decedent as described above.
We understand that Estates Code §205.007(c) provides that “[e]ach person who
execute[s] [this] affidavit is liable for any damage or loss to any person that arises from
a payment, delivery, transfer, or issuance made in reliance on the affidavit.”
STATE OF __________________ §
COUNTY OF ________________ §
I am a Distributee in the Estate of _____________________________________________, Deceased. I
swear or affirm that I have personal knowledge of the facts stated in the foregoing Affidavit and that the
facts contained in the Affidavit are true and complete to the best of my knowledge.
____________________________________ ________________________________
Distributee’s printed name Distributee’s signature
SWORN TO AND SUBSCRIBED before me by ________________________________ [name of Distributee], a
Distributee, on this the _______ day of _____________________, 20____.
____________________________
(SEAL) Notary Public, State of _____________
STATE OF __________________ §
COUNTY OF ________________ §
I am a Distributee in the Estate of _____________________________________________, Deceased. I
swear or affirm that I have personal knowledge of the facts stated in the foregoing Affidavit and that the
facts contained in the Affidavit are true and complete to the best of my knowledge.
____________________________________ ________________________________
Distributee’s printed name Distributee’s signature
SWORN TO AND SUBSCRIBED before me by ________________________________
[name of Distributee], a
Distributee, on this the _______ day of _____________________, 20____.
____________________________
(SEAL) Notary Public, State of _____________
Affidavits and signatures of two disinterested witnesses
STATE OF __________________ §
COUNTY OF ________________ §
I have no interest in the Estate of ________________________________, Deceased, and am not related
to Decedent under the laws of descent and distribution of the State of Texas. I swear or affirm that the
facts contained in this Affidavit regarding family history, assets, and liabilities are true and complete to
the best of my knowledge.
I understand that Estates Code §205.007(c) provides that “[e]ach person who execute[s] [this]
affidavit is liable for any damage or loss to any person that arises from a payment, delivery,
transfer, or issuance made in reliance on the affidavit.”
____________________________________ ________________________________
Disinterested Witness’s printed name Disinterested Witness’s signature
SWORN TO AND SUBSCRIBED before me by ________________________________ [name of witness], a
disinterested witness, on this the _______ day of _____________________, 20____.
____________________________
(SEAL) Notary Public, State of _____________
STATE OF __________________ §
COUNTY OF ________________ §
I have no interest in the Estate of ________________________________, Deceased, and am not related
to Decedent under the laws of descent and distribution of the State of Texas. I swear or affirm that the
facts contained in this Affidavit regarding family history, assets, and liabilities are true and complete to
the best of my knowledge.
I understand that Estates Code §205.007(c) provides that “[e]ach person who execute[s] [this]
affidavit is liable for any damage or loss to any person that arises from a payment, delivery,
transfer, or issuance made in reliance on the affidavit.”
____________________________________ ________________________________
Disinterested Witness’s printed name Disinterested Witness’s signature
SWORN TO AND SUBSCRIBED before me by ________________________________
[name of witness],
disinterested witness, on this the _______ day of _____________________, 20____.
____________________________
(SEAL) Notary Public, State of _____________
ORDER APPROVING SMALL ESTATE AFFIDAVIT
CAUSE NO.___________
ESTATE OF * COUNTY COURT AT LAW
_________________________ * OF
DECEASED * BASTROP COUNTY, TEXAS
On this day the Court considered the Affidavit of the distributes of the estate and
the Court finds that the above Affidavit complies with terms and provisions of the Texas
Estates Code, that this Court has jurisdiction and venue, that this estate qualifies under
the provisions of the Estates Code as a Small Estate, and that the Affidavit should be
approved.
It is ODERED AND DECREED by the Court that the forgoing Affidavit be, and
the same is hereby APPROVED, and shall forthwith be recorded in the Small Estate
Records of this County, and the Clerk of the Court shall issue certified copies thereof to
all persons entitled there to.
SIGNED THIS __________ day of _________________________________, 20_______
____________________________________
JUDGE PRESIDING
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Form updated September 1, 2017: Small Estate Affidavit (Texas Secretary of State)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 17 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document