Small Estate Affidavit for Bank Account Release
1. Decedent Information
Full Name of Decedent
Date of Death
Last Known Address
2. Affiant Information
Your Full Name
Relationship to Decedent
Address
Phone Number
3. Bank Account Information
Bank Name
Account Number
Account Balance
4. Estate Summary
Total Value of Estate
List Other Property (if any)
5. Heir(s) Information
Names and Relationships of Heirs
6. Affidavit Statement
Signature
Affiant Signature
Date
Notary Public (if required)
Notary Signature
Date
Seal/Stamp