Fill and Sign the Louisiana Small Estate Affidavit Form

- 1 - SMALL ESTATE AFFIDAVIT Louisiana Code of Civil Procedure Title V. STATE OF LOUISIANA IN THE MATTER OF THE ESTATE OF ___________________ , DECEASED. Stat e of Louisiana ___________________ Parish I, _____________ ______ , upon being duly sworn, state on my oath that: 1. My post office addre ss is: _______________________________ . 2. My residence addres s is: _______________________________ . 3. I am a successor to the decedent identified below. All successors, including myself, of the decedent are as follows: Name Relationship Address _______________________________ _____________________ _______________________________ _______________________________ _____________________ _______________________________ ______________________ _________ _____________________ _______________________________ _______________________________ _____________________ _______________________________ _______________________________ _____________________ _______________________________ _____________________________ __ _____________________ _______________________________ _______________________________ _____________________ _______________________________ - 2 - Any heir not signing the affidavit (a) c annot be located after the exercise of reasonable diligence, or (b) was given ten days notice by U.S. mail of the affiants' intent to execute an affidavit for small succession and did not object. 4. The decedent's full name is _______________________________ . 5. At the time of death, decedent was domiciled at _______________________________ and the location of the decedent ’s last residence was _______________________________ . 6. At th e time of his/her death, the decedent was unmarried divorced married other, __________________________ _____ (specify). If married, the surviving spouse’s name is _______________________________ . The surviving spouse’s address is _______________________________ , domicile is _______________________________ , and last residence is _______________________________ . Heirs who are force heirs of the deceased include ____________________________ . 7. The date of the decedent's d eath was _______________________________ . 8. The decedent died intestate. 9. Descriptions of the moveable and immoveable property and the value thereof ( small succession immoveable property may reference and attach a legal description as an exhibit ): ASSET DESCRIPTION CHARACTER DOLLAR VALUE AMOUNT _______________________________ Community Property Separate Property ___________ __________________________ _____ Community Property Separate Property ___________ _______________________________ Community Property Separate Property ___________ _______________________________ Community Property Separate Property ___________ _______________________________ Community Property Separate Property ___________ _______________________________ Community Property Separate Property ___________ - 3 - _______________________________ Community Property Separate Property ___________ Total Value= ___________ 10. The following describes the respective interests in the property which each heir has inherited and whether a legal usufruct of the surviving spouse attaches to the property: ___________________ ____________ (attach certified copies of the testament and the probate order of another state, if the affidavit is being used in lieu of an ancillary probate proceeding) 11. The following legatees of the deceased not signing this a ffidavit were given ten days notice by U.S. mail of the affiants' intent to execute an affidavit for small succession and did not object. Name Last Known Address _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ ___________________________ ____ _______________________________ _______________________________ THE ABOVE INFORMATION CONTAINED IN THIS AFFIDAVIT IS TRUE, CORRECT AND COMPLETE TO THE BEST OF OUR KNOWLEDGE, INFORMATION, AND BELIEF, AND IS MADE UNDER THE PENALTIES OF PERJURY. BY SIGNING THIS AFFIDAVIT, THE AFFIANT, IF A LEGATEE, HAS ACCEPTED THE LEGACY OF THE DECEASED. ____________ ____________________________ Signature of Affiant ________________________________________ Signature of Affiant STATE OF LOUISIANA PARISH OF __________________ On this __________ day of ___________________________ , _______________, before me personally appeared ______________________________________, to me known to be the person (or persons) described in and who executed the foregoing instrument, and acknowledge d that (he/she/they) executed it as (his/her/their) free act and deed. - 4 - _________________________________ Notary Public Print Name: _______________________ My commission expires: ___________________