Fillable SMALL ESTATE AFFIDAVIT (Illinois State Treasurer's Office)

Fill Online, Printable, Fillable, Blank SMALL ESTATE AFFIDAVIT (Illinois State Treasurer's Office) Form

Use Fill to complete blank online ILLINOIS STATE TREASURER'S OFFICE (IL) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

SMALL ESTATE AFFIDAVIT (Illinois State Treasurer's Office)

On average this form takes 17 minutes to complete

The SMALL ESTATE AFFIDAVIT (Illinois State Treasurer's Office) form is 3 pages long and contains:

  • 1 signature
  • 0 check-boxes
  • 62 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Illinois State Treasurer's Office

BROWSE ILLINOIS STATE TREASURER'S OFFICE (IL) 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
 
STATE OF ILLINOIS (See 755 ILCS 5/25-1)
COUNTY OF ___________________
SMALL ESTATE AFFIDAVIT
[to be used only when decedent died on or after January 1, 2015]
I, ______________________________________________________________________________________, on oath state:
(Name of Affiant)
1. (a) My post office address is
(b) My residence address is __________________________________________________________________; AND
(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 process in Illinois is:
Name ______________________________________________________ City
Address _____________________________________________________ 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 if not already submitted.
4. The decedent’s place of residence immediately before his/her 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 $100,000.00 and consists of the following: (Here, list each asset, e.g., cash,
stock, and its fair market value).
Funds and/or assets held with the Illinois State Treasurer’s Office
7. Please mark (X) either (a) or (b): (a) All the decedent’s funeral expenses and other debts have been paid; or (b) All
the decedent’s known unpaid debts are listed and classified as follows:
Class 1: Funeral and burial expenses, which include reasonable amounts paid for a burial space, crypt, or niche; a marker
on the burial space; and care of the burial space, crypt, or niche; expenses of administration; and statutory custodial
claims:
Name
Post Office Address __________________________________________ Amount
Class 2: Surviving spouse’s award or child’s award, if applicable:
Name
Post Office Address __________________________________________ Amount
Class 3: Debts due the United States:
Name
Post Office Address __________________________________________ Amount
Class 4: Money due employees of the decedent of not more than $800 for each claimant for services rendered within four (4) months
prior to the decedent’s death and expenses attending the last illness:
Name
Post Office Address __________________________________________ Amount
Class 5: Money and property received or held in trust by the decedent that cannot be identified or traced:
Name
Post Office Address __________________________________________ Amount
Class 6: Debts due the State of Illinois and any county, township, city, town, village, or school district located within Illinois:
Name
Post Office Address __________________________________________ Amount
Class 7: All other claims:
Name
Post Office Address __________________________________________ Amount
7.5 I understand that all valid claims against the decedent’s estate described in paragraph 7 must be paid by me from the decedent’s estate
before any distribution is made to any heir or legatee. I further understand that the decedent’s estate should pay all claims in the order
set forth above, and if the decedent’s estate is insufficient to pay the claims in any one class, the claims in that class shall be paid pro
rata.
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 Relationship
Place of Residence
Age of 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 $_________________ ($20,000, plus
$10,000 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 decedent’s death, so
indicate in 9a).
(c) If there is no surviving spouse, the award allowable to the minor children and adult dependent children of a decedent who
was an Illinois resident is $_______________ ($20,000, plus $10,000 multiplied by the number of minor children and adult
dependent children), to be divided among them in equal shares.
10. Indicate either 10a or 10b by marking (X) the correct box.
(a) The Decedent left no will. The names, places of residence and relationships of the decedent’s heirs, and the
portion of the estate to which each heir is entitled under the law where decedent died intestate are as follows:
Name, Relationship and Place of Residence
Age of Minor
Portion of Estate
(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 admittable 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 and Place of Residence
Age of Minor
Portion of Estate
(c) Affiant is unaware of any dispute or potential conflict as to the heirship or will of the decedent.
10.3 My relationship with the decedent or the decedent’s estate is as follows ______________________________
10.5
I understand that the decedent’s estate must be distributed first to satisfy claims
against the decedent’s estate as set forth in paragraph 7.5 of this affidavit before
any distribution is made to any heir or legatee. By signing this affidavit, I agree
to indemnify and hold harmless all creditors of the decedent’s or financial
institutions relying upon this affidavit who incur any loss because of reliance on
this affidavit, up to the amount lost because of any act or omission by me. I
further understand that any person, corporation or financial institution
recovering under this indemnification provision shall be entitled to reasonable
attorney’s fees and the expenses of recovery.
11. After payment by me from the decedent’s estate of all debts and expenses listed in paragraph 7, any remaining property
described in paragraph 6 of this affidavit should be distributed as follows:
Name
Specific Sum or Property to be Distributed
The foregoing statement is made under the penalties of perjury. (Note: A fraudulent statement made under the penalties of
perjury is perjury, as defined in Section 32.2 of the Criminal Code of 2012.)
_________________________________________________________ ____________________________________
Signature of Affiant Date Daytime Telephone Number
Signed and sworn before me on this ______day of __________________, ______
______________________________________________
Notary Public
My Commission expires _____________________
IF ADDITIONAL SPACE IS NEEDED, PLEASE ATTACH REQUESTED INFORMATION.
click to sign
signature
click to edit
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

SMALL ESTATE AFFIDAVIT (Illinois State Treasurer's Office)

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 20 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document