The Connecticut small estate affidavit, also known as ‘Form PC-212’ or ‘Affidavit in Lieu of Probate of Will/ Administration’, is used when the estate of a person who died does not exceed $40,000 in value and the decedent does not solely own any real estate. In other words, this form can be used if the decedent had an interest in real estate that passed to a joint owner, but not if the decedent owned it by himself. This form allows for expedited settlement of a small estate and must be filed in the Probate Court representing the county in which the decedent resided at the date of death.

Maximum – $40,000

Laws – Sec. 45a-273

If Applicable – Request for Order of Redistribution (Form PC-212A)

How to Write

1 – Access Form PC-212

Utilize the button beneath the preview image to access this form directly from this page. You may open it or save it at your discretion, however, it is recommended to save it, then work on it.

2 – Identify The Court

Locate the first blank space, under the words “Probate Court Name,” then report the exact Name of the Court handling the Probate matter of the Decedent. Adjacent to this, report this court’s “District Number” in the appropriate area.

3 – Report Decedent Information

Next list all the Names, Aliases, and Initials under which the Decedent’s Assets were held.

Record the Decedent’s Home Address at the Time of Death. Make sure this is a complete Address with a Building Number, Street, Suit Number (if applicable), City, State, and Zip Code. In the adjacent area, report the Decedent’s Date of Death.

4 – Document Petitioner Information

Locate the box labeled “Petitioner,” then report the Name, Address, and Daytime Telephone Number of each Petitioner being represented by this form. List the Relationship the Petitioner has with the Decedent on the blank space beneath the words “Relationship to Decedent, if any.”

Next, following the words “The Petitioner represents that,” mark the first box if the Petitioner is the surviving spouse. If there is no surviving spouse and the Petitioner is a next of kin to the Decedent then, mark the second checkbox. If the Petitioner is neither the surviving spouse or next of kin, but has some other claim on the Decedent’s Property then mark the third box and report the Petitioner’s interest in the Decedent’s Estate in the area provided. If no petition is pending in any Probate Court, then mark the fourth box

5 –  Define The Decedent’s Estate Status

Indicate it the Decedent received aid or care from the state of Connecticut by marking the box preceding the words “did” or “did not” accordingly.

At the top of the next page, mark the first box it the Decedent left a will then, enter the Date of the Will on the blank space in this statement. If the Decedent did not leave a will, then mark the second checkbox (labeled “The decedent left no will.”

List the Decedent’s Assets at his or her Time of Death using the area below the words Assets. Describe these Assets below the area labeled “Description” (i.e. a Vehicle’s VIN Number) then enter the Fair Market Value (i.e. a Vehicle’s Blue Book Value) of that asset to the right. Make sure the Decedent is the sole owner of each Asset listed here. Make sure to total the values of these assets at the bottom of the Fair Market Value column

If there are any Expenses or Claims on the Decedent’s Estate, these may be listed using the chart labeled “Expenses and Claims.” There will be several categories: Funeral Expenses, Administration Expenses, Taxes (due in CT), Claims due to Last Sickness (of Decedent), and Other Claims. Each will have a row of its own. Use the two columns to the right of these categories to list the Creditor of each Item and the Total Amount owed for that category in the third column. Note: If the item being listed has already been paid for, then you must list the Name of the entity who has submitted that payment.

Locate the top of the next page. If the Funeral Director has not been paid and the Petitioner requests a court order payment from the assets above, then mark the box preceding the words “The funeral director….”

If the Decedent’s Creditors have not been paid and the Petitioner requests a court order payment, then mark the box preceding the words “The following creditors…” Note: If this is the case, then make sure to list the creditors in the space provided.

If the expenses, claims, and taxes listed in the table have been paid according to C.G.S. section 45a -365, if the Decedent received care or aid from the State of Connecticut, or if the Decedent is obligated to pay incarceration costs (as per C.G.S. sections 17b-95 or 18-85b), then mark the checkbox preceding the words “The expenses…”

If the Decedent’s Assets exceed the expenses and claims, then attach a completed form PC-212A and mark the box labeled “Assets exceed expenses…”

If Form PC-212A is attached and lists children who are not those of the surviving spouse, then mark the box preceding the words “One or more…”

Mark the checkbox preceding the words “Wherefore, the petitioner requests…” if the Petitioner wishes the courts to authorize the transfer of the above assets, sale of assets, and payments of proceeds as listed on this document.

The last portion requiring information applies only if the Decedent’s estate was originally opened as a full estate but qualifies for small estate procedure (C.G.S. section 45a-273). Mark the checkbox preceding the word “Wherefore…” then mark the checkbox preceding the words “an inventory,” “return of claims,” and/or “final financial report,” should the Petitioner wish the court to forego these items rather than require administration.

6 – Petitioner Signature

Locate the words “The representations contained in this affidavit are made….” The Petitioner must sign his or her Name on the blank space labeled “Signature of Petitioner,” then report the Signature Date on the line labeled “Date.”

The last page of this form is for the use of the Connecticut Courts. Do not fill in any of the items below the words “For Court Use Only.”