Fillable Texas Small Estate Affidavit Form

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Texas Small Estate Affidavit Form

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The Texas Small Estate Affidavit Form form is 9 pages long and contains:

  • 4 signatures
  • 2 check-boxes
  • 151 other fields

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Small Estate Affidavit Form, October 2017 Page 1 of 9
NO. -_____-_________________
Estate of
______________________________,
Deceased
§
§
§
§
§
§
§
§
§
§
§
In the ______________
(Court Number)
Probate Court
County Court/County Court at Law
of:
_____________________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. [If not in this County, the affidavit must include facts supporting venue in this
County.]
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 total value of Decedent’s estate assets on the date of this affidavit, not including homestead and
exempt property, is $75,000.00 or less.
G. The total value of Decedent’s estate assets, not including homestead and exempt property, exceeds
the total value of 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
Small Estate Affidavit Form, October 2017 Page 2 of 9
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 each asset 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.
$$ value of
Decedent’s
interest on date
of affidavit
For each asset, list the
value of Decedent’s
interest in that asset.
An affidavit cannot be
approved with an asset
of “unknown” value.
Additional information
1. If decedent was married, indicate:
whether each asset was community or separate
property, and
facts that explain why the asset was community or
separate, and
total value of each community property asset.
2. If decedent was survived by a spouse, minor children, or
unmarried adult children who lived with decedent, the list of
known estate assets must indicate which assets applicant
claims are exempt. See checklist for more information.
Use additional pages as necessary.
Small Estate Affidavit Form, October 2017 Page 3 of 9
Description of Asset(s)
List each asset with enough detail to
identify exactly what the asset is.
For example, give bank name and
last four digits of an account number;
give life insurance company name;
give description of car plus VIN
number; give address & legal
description of real property.
$$ value of
Decedent’s
interest on date
of affidavit
For each asset, list the
value of Decedent’s
interest in that asset.
An affidavit cannot be
approved with an asset
of “unknown” value.
Additional information
1. If decedent was married, indicate:
whether each asset was community or separate
property, and
facts that explain why the asset was community or
separate, and
total value of each community property asset.
2. 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 must be listed here, as of the date the
affidavit is signed. The affidavit must list all of Decedent’s existing 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.
Balance Due
(Continue list as necessary. If list is continued on another page, please note.)
Small Estate Affidavit Form, October 2017 Page 4 of 9
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.)
Small Estate Affidavit Form, October 2017 Page 5 of 9
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 child
died after the Decedent, talk with a lawyer 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.
Small Estate Affidavit Form, October 2017 Page 6 of 9
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 deceased brother
or sister (nephews and nieces of
Decedent) that were alive on the date
Decedent died. If any died before
Decedent died, contact the Court.
Birth dates of
nieces & nephews
(Continue list as necessary. If list is continued on another page, please note.)
Small Estate Affidavit Form, October 2017 Page 7 of 9
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 L of the
Instructions & Forms Using a Small Estate to Probate an Estate in Texas and the Texas Descent
and Distribution Chart.
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
(this column
MUST be filled
out)
Share of separate
real property
(this column MUST
be filled out, even if
you do not list any
real property)
Share of decedent’s
community property
(if decedent was
married, you must
always fill out this
column)
(Continue list as necessary. If list is continued on another page, please note.)
Small Estate Affidavit Form, October 2017 Page 8 of 9
M. Affidavits and signatures of all Distributee(s).
As needed, include other signature pages for additional distributees.
*** Every signature page for every 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 _____________________ County Clerk; that the
(Fill-in the name of County)
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 _____________
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Small Estate Affidavit Form, October 2017 Page 9 of 9
N. 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], a disinterested witness, on this the _______ day of _____________________, 20____.
_______________________________
(SEAL) Notary Public, State of _____________
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Texas Small Estate Affidavit Form

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Completed 17 February 2022

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