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Small Estate Affidavit 3764 - Illinois

Small Estate Affidavit Form. This is a Illinois form and can be used in Probate Kendall Local County .
 Fillable pdf Last Modified 1/9/2006
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SMALL ESTATE AFFIDAVIT 3764 (Rev. 12/04) 755 ILCS 5/25-1 Payment or delivery of small estate of decedent upon affidavit (a) When any person or corporation (1) indebted to or holding personal es tate of a decedent, (2) controlling the right of access to the deceden ts safe deposit box, or (3)acting as a registrar or transfer agent of any evidence of interest, ind ebtedness, grant access to the safe deposit box, deliver the personal es tate or transfer or issue the evidence of interest, indebtedness, property or right to persons and in manner specified in paragraph 11 of the affidavit or to an agent appoint ed as hereinafter set forth. STATE OF ILLINOIS COUNTY OF KENDALL SMALL ESTATE AFFIDAVIT I on oath states: 1. (a) my post office address is (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 proce ss in Illinois is: Name: Address: City/State/Zip: Telephone: I understand that if no person is named above as my agent for service, o r if for any reason, service on the named person cannot be effectuated, the Clerk of the 18th Judicial Circuit Court of D uPage County is recognized by Illinois law as my agent for the service of process. 2. The decedents name is 3. The date of the decents death was , and I have attached a copy of the death certificate hereto. 4. The decedents place of residence immediately before death was 5. No letters of office are now outstanding on the decedents estate and no petition for letters is contemplated or pending in Illinois or in any other jurisdiction, to my knowledge. 6. The gross value of the decedents entire personal estate, including t he value of all property passing to any party either by intestacy or under a will, does not exceed $100,000. (list each asse t, e.g., cash, stock and its fair market value): 7. (a) All of the decedents funeral expenses have been paid, or (b) the amount of the decedents unpaid funeral expenses and the name and post office address of each person entitled thereto are as follows: (strike either (a) or (b)) NAME AND POST OFFICE ADDRESS AMOUNT 8. There is no known unpaid claimant or contested claim against the deceden t, except as stated in paragraph 7. 9. (a) The names and places of residence of any surviving spouse, minor c hildren and adult dependant* children of the decedent are as follows: NAME AND RELATIONSHIP PLACE OF RESIDENCE AGE OF MINOR CHILD (*NOTE: An adult dependant child is one who is unable to maintain himse lf and is likely to become a public charge.) (b) the award allowable to the surviving spouse of a decedent who was an Il linois resident is $ ($10,000, plus $5,000 multiplied by the number of minor children and ad ult dependant children, who resided with the surviving spouse at the time of the decedents death. If any such child did not reside with the surviving spouse at the time of the decedents death, so indicate. (c) If there is no surviving spouse, the award allowable to the minor child ren and adult dependant children of the decedent who was an Illinois resident is $ ($10,000 plus $5,000 multiplied by the number of minor children and adult dependent children), to be divided among them in equal shares. BECKY MORGANEGG, CLERK OF THE 16TH JUDICIAL CIRCUIT COURT YORKVILLE, ILLINOIS 600560 American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 2SMALL ESTATE AFFIDAVIT 3764 (Rev. 12/04) 10. (a) The decedent left no will. The names, places of residence and rel ationship of the decedents heirs, and the portion of the estate to which each heir is entitled under the law where the decedent died intestate are as follows: OR (b) the decedent left a will, which has been filed with the Clerk o f the appropriate court. A certified copy of the will on file is attached. To the best of my knowledge and belief the will on file is the decedents last will and was signed by the decedent and the attesting witnesses as required by law and would be admittable t o probate. The names and places of residence of the 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 (c) Affiant is unaware of any dispute or potential conflict as to the heirs hip of will of the decedent. 11. The property described in paragraph 6 of this affidavit should be distr ibuted as follows: NAME SPECIFIC SUM OR PROPERTY TO BE DISTRIBUTED The foregoing statement is made under the penalties of perjury* Signature of Affiant *(Note: A fraudulent statement made under the penalties of perjury is p erjury as defined in 720 ILCS 5/32-2) (c) Appointment of Agent. If safe deposit access is involved or if sale of any personal property is desirable to facilitate distribution pursuant to the small claims affidavit, all persons named i n paragraph 11 of the small estate affidavit (excluding minors and unascertained or disabled persons) may in writing appoint on e or more persons as their agent for that purpose. The agent shall have power without court approval, to gain access to, sell a nd distribute property for the benefit of all persons named in paragraph 11 of the affidavit; the payment, delivery, transfer, access or issuance shall be made or granted to or on the order of the agent. (d) Release. Upon payment, delivery, transfer, access or issuance pursuant to a properly to a properly executed affidavit, the person or corporation is released to the same extent as if the payment, delivery, transfer, access or issuance is made or given is answerable therefore to any representative of the estate. (e) The affiant signing the small estate affidavit prepared pursuant to sub sections (b) of this Section shall indemnify and hold harmless all creditors and heirs of the decedent and other persons relyi ng upon the affidavit who incur loss because of such reliance. That indemnification shall only be up to the amount lost becau se of the act or omission of the affiant. Any person recovering under this subsection (e) shall be entitled to reasonable a ttorneys fees and the expenses of recovery. (f) The affiant of a small estate affidavit who is a non-resident of Illino is submits himself or herself to the jurisdiction of Illinois courts for all matters related to the preparation or use of the affidavit. The affidavit
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