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VIRGINIA SMALL ESTATE ACT AFFIDAVIT
Va. Code §64.2-600 & 601
Note to the “Person” to whom this Affidavit is delivered: Any person having possession of a small asset shall pay or
deliver the small asset to the designated successor of the decedent upon being presented an affidavit made by all of the
known successors. If you do not understand or have questions regarding your legal responsibilities relative to this
Affidavit, you should consult an attorney at law. “Person" means any individual, corporation, business trust, fiduciary,
estate, trust, partnership, limited liability company, association, joint venture, government, governmental subdivision,
agency, or instrumentality, public corporation, or any other legal or commercial entity.
I/WE, the “Successor(s)”
___________________________________________________________________________________, after being
first duly sworn, depose and state as follows:
1. That ________________________________________, the “Decedent”, died on the _______ day of
_________________, 20_____.
2. That at the time of death, the Decedent’s estate consisted only of a “Small Asset”. "Small asset" means any
indebtedness owed to or any asset belonging or presently distributable to the decedent, other than real property,
having a value, on the date of the decedent's death, of no more than $50,000. A small asset includes any bank account,
savings institution account, credit union account, brokerage account, security, deposit, tax refund, overpayment, item
of tangible personal property, or an instrument evidencing a debt, obligation, stock, or chose in action. Upon
presentation of this affidavit, the designated successor may endorse, or negotiate any small asset that is a check, draft,
or other negotiable instrument that is payable to the decedent or the decedent’s estate.
A description of the Small Asset appears below:
Bank Account Savings Institution Account Credit Union Account Brokerage Account Security
Deposit
Tax Refund Overpayment Tangible Personal Property Instrument Evidencing a Debt (i.e.
promissory note)
Obligation (i.e. a contract right) Stock Chose in Action (i.e. right to sue)Description of
Small Asset (if required by recipient of Affidavit)
_____________________________________________________________________________________________
3. That the value of Decedent’s entire personal probate estate as of the date of the decedent’s death, wherever located,
does not exceed $50,000.00.
4. That at least 60 days have elapsed since the Decedent’s death.
5. That no application for the appointment of a personal representative is pending or has been granted in any
jurisdiction.
6. That the Decedent’s will, if any, was duly probated.
7. That the claiming Successor is entitled to payment or delivery of the small asset and the basis upon which such
entitlement is claimed appears below (check all that apply):
"Successor" means any person, other than a creditor, who is entitled under the decedent's will or the laws of intestacy
to part or all of a small asset.
Surviving Spouse Beneficiary under Will Heir (no Will) Other
If Other, describe relationship to the Decedent: _________________________________
8. The names and addresses of all Successors, to the extent known, are:
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
