Fill and Sign the Missouri Small Form

SMALL ESTATE AFFIDAVIT Collection of Personal and Real Property Missouri Revised Statutes Section 473.097 State of Missouri County of ______________ I, ____________________________________________________________________, upon being duly sworn, state on my oath that: 1. My post office address is: __________________________________________________ My residence address is: ___________________________________________________ 2. The decedent's name is: ___________________________________________________ 3. The date of the decedent's death was____________________________________, and I have have not attached a copy of the death certificate hereto. 4. That the decedent left no Will left a Will and it was presented for probate within the time limits specified in section 473.050. 5. That the entire value of the estate, less liens and encumbrances, does not exceed Forty Thousand Dollars ($40,000.00). [ Note: this does not include property held by the decedent as a tenant by the entirety or a joint tenant at the time of his death.] 6. That at least thirty (30) days have elapsed since the death of the decedent. 7. The following is an itemized description and valuation of the property of the decedent: A. Description: _______________________________________________________ Value: ___________________________________________________________ B. Description: _______________________________________________________ Value: ___________________________________________________________ C. Description: _______________________________________________________ Value: ___________________________________________________________ D. Description: _______________________________________________________ Value: ___________________________________________________________ E. Description: _______________________________________________________ Value: ___________________________________________________________ 1 8. I am a distributee Personal Representative of the estate of the decedent identified below as defined in M.R.S. 473.097. All persons entitled to and who will receive specific items of the decedent’s property are: Name Address A. ________________________________ ________________________________ Relationship: ________________________ Basis of Claim: _______________________ Person having possession of property: _________________________________________ B. ________________________________ ___________________________________ Relationship: ________________________ Basis of Claim: _______________________ Person having possession of property: _________________________________________ C. ________________________________ ________________________________ Relationship: ________________________ Basis of Claim: _______________________ Person having possession of property: _________________________________________ D. ________________________________ ___________________________________ Relationship: ________________________ Basis of Claim: _______________________ Person having possession of property: _________________________________________ E. ________________________________ ________________________________ Relationship: ________________________ Basis of Claim: _______________________ Person having possession of property: _________________________________________ F. ________________________________ ___________________________________ Relationship: ________________________ Basis of Claim: _______________________ Person having possession of property: _________________________________________ 9. A bond, in an amount not less than the value of the personal property, approved by the judge or clerk of the probate division, has been filed by the affiant that makes this affidavit, conditioned upon the payment of the debts of the decedent, including any debts to the state of Missouri, the expenses of funeral and burial and compliance with future orders of the court in relation to the estate of the decedent; and further conditioned that any part of the property to which the distributee is not entitled will be delivered to the persons entitled to the property under the law. OR The court has dispensed with the need for filing of a bond. 2 10. All unpaid debts, claims or demands against the decedent or the decedent's estate and all estate taxes due, if any, on the property transfers involved have been or will be paid, except that any liability by the affiant for the payment of unpaid claims or demands shall be limited to the value of the property received. THE FOREGOING STATEMENT IS MADE UNDER THE PENALTIES OF PERJURY. ________________________________________ Signature of Affiant State of Missouri County of _____________ On this ____ day of ________________ in the year ____, before me, __________________ (name of notary), a notary public in and for said state, personally appeared __________________ (name of individual), known to me to be the person who executed the within ________________ (type of document), and acknowledged to me that he/she executed the same for the purposes therein contained. In witness whereof, I hereunto set my hand and official seal. __________________________________ Notary Public 3