Small Estate Affidavit

What is the name of the person who died?

First

Last

Also known as the "Decedent."

Residence

What was the primary residence of the person who died?

This is where the person had a driver's license.

Location of Death

County of

The County (not country) where the individual (decedent) passed away.

State of

Date of Death

When did the Decedent die?

The date the decedent's death should be the same date as written in the decedent's death certificate.

Assets/Debt

Are the Assets of the Decedent's estate GREATER or LESS THAN the Decedent's Debt?

GreaterLess Than

Typically for the heir to receive an inheritance, the decedent's assets should be greater than his/her debt.

Heir of Contact

Who is the Person filing this Document?

First

Last

Also known as the "Heir of Contact"

Mailing Address

Street Address

Address Line 2

City

State

ZIP Code

Please enter your address.

Pending Lawsuits

Are there any Pending Lawsuits over the Decedent's estate?

YesNo

Describe any pending lawsuits or litigation:

State Laws

Which State will the Decedent's property be distributed?

What is being claimed under this Small Estate?

Bank account ($10,000 maximum)Life Insurance ($11,000 maximum)Patient's Care Account ($10,000 maximum)Personal Property ($50,000 maximum)Wages, salary or employee benefits ($10,000 maximum)Unclaimed Property ($11,000 maximum)

Only 1 item may be claimed per Small Estate Affidavit in Pennsylvania. If there is more than one (1) item the Affiant will be required to complete another form. If the Affiant is claiming a vehicle then

How many Heirs?

How many descendants (heirs) are there to the Decedent?

Heir(s)

This is the number of individuals receiving a portion of the estate from the Decedent.

Name of Heir #1

First

Last

How was Heir #1 related to the Decedent?

What Property (with value) is Heir #1 Entitled to?

Name of Heir #2

First

Last

How was Heir #2 related to the Decedent?

What Property (with value) is Heir #2 Entitled to?

Name of Heir #3

First

Last

How was Heir #3 related to the Decedent?

What Property (with value) is Heir #3 Entitled to?

Name of Heir #4

First

Last

How was Heir #4 related to the Decedent?

What Property (with value) is Heir #4 Entitled to?

Name of Heir #5

First

Last

How was Heir #5 related to the Decedent?

What Property (with value) is Heir #5 Entitled to?

Name of Heir #6

First

Last

How was Heir #6 related to the Decedent?

What Property (with value) is Heir #6 Entitled to?

Name of Heir #7

First

Last

How was Heir #7 related to the Decedent?

What Property (with value) is Heir #7 Entitled to?

Name of Heir #8

First

Last

How was Heir #8 related to the Decedent?

What Property (with value) is Heir #8 Entitled to?

Name of Heir #9

First

Last

How was Heir #9 related to the Decedent?

What Property (with value) is Heir #9 Entitled to?

Name of Heir #10

First

Last

How was Heir #10 related to the Decedent?

What Property is Heir #10 Entitled to?

Name of Heir #11

First

Last

How was Heir #11 related to the Decedent?

What Property (with value) is Heir #11 Entitled to?

Name of Heir #12

First

Last

Text InputHow was Heir #12 related to the Decedent?

What Property (with value) is Heir #12 Entitled to?

Name of Heir #13

First

Last

How was Heir #13 related to the Decedent?

What Property (with value) is Heir #13 Entitled to?

Name of Heir #14

First

Last

How was Heir #14 related to the Decedent?

What Property (with value) is Heir #14 Entitled to?

Name of Heir #15

First

Last

How was Heir #15 related to the Decedent?

What Property (with value) is Heir #15 Entitled to?

Additional Assets

Are there any Additional Assets or Property?

YesNo

Describe any Additional Assets

Who is Entitled to the Above-Mentioned Property?

Heir's Debts & Liabilities

Does the Decedent’s Estate have any Liabilities or Debts?

YesNo

List All Liabilities and Debts (Include the amount owed and the Creditor's Information)

Signing

In which County will this Affidavit be Signed?

County

Enter the County (not country) where this affidavit will be signed.

In which State will this Affidavit be Signed?

On what Day will this Affidavit be Signed?

Select a date.

Death Certificate

Do you Agree to Submit a Copy of the Decedent's Death Certificate Along with this Affidavit?

I Agree

According to State Law, it is mandatory that you submit a copy of the decedent's death certificate along with this affidavit.

Notice to Heirs

I Agree to give notice to ALL Heirs within at least 30 days of filing this form

Yes

Signature

Who will be Present when this Document is Signed?

Notary PublicTwo (2) WitnessesNotary Public and Two (2) Witnesses (Recommended)

It is recommended that this form be signed in front of a notary public. A notary public can be found at every branch bank or credit union in the United States.