Small Estate Affidavit
State:
County:
Court:
Case No.:
Decedent Information
Full Name of Decedent:
Date of Death:
Address at Time of Death:
Affiant Information
Your Name:
Your Address:
Your Relationship to Decedent:
Heirs / Beneficiaries
Name
Address
Relationship
Assets of the Estate
Description of Asset
Value
Statements or Additional Information:
Date:
Signature of Affiant:
Printed Name:
Notary Public:
Commission Expires: