Illinois > Local County > Dupage > Probate
Small Estate Affidavit 3764 - Illinois
| Small Estate Affidavit Form. This is a Illinois form and can be used in Probate Dupage Local County . |
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COURT SMALL ESTATE AFFIDAVIT COUNTY OF Payment or delivery of small estate of decedent upon affidavit (a) When any person or corporation (1) indebted to or holding personal estate of a decedent, (2) controlling the right of access to the decedent's safe deposit box, or (3) acting as a registrar or transfer agent of any evidence of interest, indebtedness, grant access to the safe deposit box, deliver the personal estate or transfer or issue the : Calendar No. evidence of interest, indebtedness, property or right to persons and in manner specified in paragraph 11 of the affidavit or to an agent appointed as hereinafter set forth. ...................................................... 755 ILCS 5/25-1 : 3764 (Rev.12/04) Index No. STATE OF ILLINOIS I 1. (a) my post office address is SMALL ESTATE AFFIDAVIT Plaintiff(s) : : : JUDICIAL SUBPOENA COUNTY OF DU PAGE on oath states: -against- (b) my residence address is : (c) I understand, 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 of process in Illinois is: Defendant(s) : Name: ...................................................... Address: City/State/Zip: Telephone: 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 18th Judicial Circuit Court of DuPage County is recognized by Illinois law as my TO agent for the service of process. 2. The decedent's name is 3. The date of the decent's death was , and I have attached a copy of the death certificate hereto. THE PEOPLE OF THE STATE OF NEW YORK GREETINGS: 4. The decedent's place of residence immediately before 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 , at the Court Illinoisthe in any other jurisdiction, to my knowledge. or Honorable located at County of 6. The gross valueof the decedent's entire personal estate, including the value of all property passing to any party either in roomunder a will,, does not exceed $100,000. (list each20 on the day of , asset, e.g., cash, stock and its fair market value): at any recessed , at o'clock in the noon, and by intestacy or WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before or adjourned date, to testify and give evidence as a witness in this action on the part of the 7. (a) All of the decedent's funeral expenses have been paid, or (b) the amount of the decedent's unpaid funeral expenses and the name and post office address of each person entitled thereto are as follows: (strike either (a) or (b)) Your failure to comply NAME AND POST OFFICE ADDRESS with this subpoena is punishable as a contempt of court and will make you liable to AMOUNT the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. Witness, Honorable Court in County, , one of the Justices of the day of , 20 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 dependant* children of the decedent are as follows: NAME AND RELATIONSHIP PLACE OF RESIDENCE (Attorney must sign above and type name below) AGE OF MINOR CHILD Attorney(s) for (*NOTE: An adult dependant 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 $ ($10,000, plus $5,000 multiplied by the number of minor children and adult dependant children, who resided with the Office and P.O. Address 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. (c) If there is no surviving spouse, the award allowable to the minor children and adult dependant children of the decedent Telephone No.: who was an Illinois resident is $ ($10,000 plus $5,000 multiplied by the number of minor Facsimile No.: children and adult dependant children), to be divided among them in equal shares. E-Mail Address: CHRIS KACHIROUBAS, CLERK OF THE 18TH JUDICIAL CIRCUIT COURT Mobile Tel. No.: WHEATON, ILLINOIS 60189-0707 American LegalNet, Inc. www.USCourtForms.com COURT SMALL ESTATE AFFIDAVIT COUNTY OF ...................................................... 10. (a) The decedent left no will. The names, places of residence and relationship of: the decedent's heirs, and the portion of the Index No. estate to which each heir is entitled under the law where the decedent died intestate are as follows: 3764 (Rev.12/04) : Calendar No. OR (b) the decedent left a will, which has been filed with the Clerk of the appropriate court. A certified copy of the will on file : JUDICIAL SUBPOENA Plaintiff(s) 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 -against: legatees and the portion of the estate, if any, to which each legatee is entitled are as follows: (strike (a) or (b) NAME, RELATIONSHIP & PLACE OF RESIDENCE AGE OF MINOR CHILD PORTION OF ESTATE : : Defendant(s) : ...................................................... (c) Affiant is unaware of any dispute or potential conflict as to the heirship of will of the decedent. THE PEOPLE OF THE STATE OF NEW YORK 11. The property described in paragraph 6 of this affidavit should be distributed as follows: TO SPECIFIC SUM OR PROPERTY TO BE DISTRIBUTED NAME GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed The foregoing statement is made under the penalties of as a witness in this action on the part of the or adjourned date, to testify and give evidence perjury* Signature of Affiant Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a *(Note: A resul
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