Under 755 Ill. Comp. Stat. 5/25-1, where the gross value of the decedent’s personal estate does not exceed $100,000.00, a person indebted to or holding personal estate of the decedent must pay the indebtedness or deliver the personal estate when another person presents a proper affidavit and a copy of the decedent’s death certificate.

The affidavit must be substantially in the form set forth in 755 Ill. Comp. Stat. 5/25-1(b):

“I (name of affiant), on oath state:

1. a. 

   The affiant’s address, which may include:

   • •

     My post office address is: _____;

   • •

     My residence address is: _____; and

   • •

     I understand that, 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:

     •  

       NAME

     •  

       ADDRESS

     •  

       CITY

     •  

       TELEPHONE (IF ANY)

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 circuit court of …(County) (Judicial Circuit) Illinois is recognized by Illinois law as my agent for service of process.

1. b. 

   The decedent's name is _____;

2. c. 

   The date of the decedent's death was _____; and I have attached a copy of the death certificate hereto;

3. d. 

   The decedent's place of residence immediately before his death was ______;

4. e. 

   No letters of office are now outstanding on the decedent's estate and no petition for letters is contemplated or pending in Illinois or any other jurisdiction, to my knowledge;

5. f. 

   The gross value of the decedent's entire personal estate, including the value of all property passing to any party either by intestacy or under a will, does not exceed $100,000. (Here, list each asset, e.g., cash, stock, and its fair market value);

6. g. 

   Statement regarding funeral expenses that:

   1. 1. 

      All of the decedent’s funeral expenses have been paid, or

   2. 2. 

      The amount of the decedent’s unpaid funeral expenses and the name and post office address of each person entitled thereto are as follows:

      • •

        Name and post office address

      • •

        Amount

   NOTE: Strike either g(1) or g(2).

7. h. 

   There is no knowledge of an unpaid claimant or contested claim against the decedent, except as stated in paragraph g.

8. i. 

   Information for survivors:

   1. 1. 

      The names and places of residence of any surviving spouse, minor children and adult dependent* children of the decedent are as follows:

      • •

        Name and relationship;

      • •

        Place of residence; and

      • •

        Age of minor child

      *Note: An adult dependent child is one who is unable to maintain himself or herself and is likely to become a public charge.

   2. 2. 

      The award allowable to the surviving spouse of a decedent who was an Illinois resident is $..... ($20,000 plus $10,000 multiplied by the number of minor children and adult dependent children who resided with the 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).

   3. 3. 

      If there is no surviving spouse, the award allowable to the minor children and adult dependent children of a decedent who was an Illinois resident is $... ($20,000 plus $10,000 multiplied by the number of minor children and adult dependent children), to be divided among them in equal shares.

9. j. 

   Statement regarding a will:

   1. 1. 

      The decedent left no will

      The names, places of residence and relationships of the decedent’s heirs, and the portion of the estate to which each heir is entitled under the law where decedent died intestate are as follows:

      • •

        Name and relationship;

      • •

        Age of minor;

      • •

        Portion of estate; and

      • •

        Place of residence.

   2. 2. 

      The decedent left a will that is filed with the clerk of an appropriate court. A certified copy of the will on file is attached to the affidavit. 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 legatees and the portion of the estate, if any, to which each legatee is entitled are as follows:

      • •

        Name and relationship;

      • •

        Age of minor;

      • •

        Portion of estate; and

      • •

        Place of residence.

      Strike either j(1) or j(2).

   3. 3. 

      Affiant is unaware of any dispute or potential conflict as to the heirship or will of the decedent.

10. k. 

    The property described in paragraph f. of this affidavit should be distributed as follows:

    • •

      Name

    • •

      Specific sum or property to be distributed

    Make the foregoing statement under the penalties of perjury*.

    ...............................

    Signature of Affiant

    *(Note: A fraudulent statement made under the penalties of perjury is perjury, as defined in Section 32-2 of the Criminal Code of 2012.)

Payment of an underpayment to a person presenting a properly completed affidavit releases us to the same extent as if we made the payment to the representative of the estate. For payment of small estate upon affidavit, see 755 Ill. Comp. Stat. 5/25-1(d).