Fill and Sign the Tennessee Estate Form

IN THE CHANCERY COURT FOR       COUNTY, TENNESSEE ESTATE OF:           ) ) NO.       SMALL ESTATE AFFIDAVIT Small Estate Affidavit Page 1 of 2 states: After being duly sworn, the affiant,       , Small Estate Affidavit Page 2 of 2 1. The decedent, age       , died on the       day of       , 20       , and was last a resident of       County, Tennessee. 2. The decedent left a will, which is filed with this affidavit and deposited with the Court for safekeeping.. did not leave a will. 3. The decedent left the following unpaid debts at death: CREDITOR ADDRESS AMOUNT                                                                                                             4. The decedent died owning the following personal property: ITEM LOCATION AND POSSESSION VALUE                                                       5. The decedent owned the following life insurance policies payable to the estate: INSURANCE COMPANY POLICY NUMBER AMOUNT                                                       6. The following are the devisees, legatees or heirs entitled to receive any of decedent’s property: NAME ADDRESS AGE RELATION                                                                                                 Small Estate Affidavit Page 3 of 2                         Affiant elects does not elect to give notice to creditors in the manner required for regular administration. The decedent was was not enrolled in the TennCare program at the time of death. Affiant evidences by signature that, subject to the penalty of perjury, this affidavit is not false or misleading and the affiant is mindful of all duties imposed upon affiant by T.C.A. § 30-4-101 et seq. No clerk or assistant shall be liable as a result of services rendered to affiant in good faith in completing the affidavit based upon information furnished by affiant. Signature of Affiant       Type or Print Name STATE OF TENNESSEE , COUNTY OF       Personally appeared before me the said       , and after being duly sworn deposes and says that the facts averred in the above affidavit are true to the best of his knowledge, information, and belief, this the       day of       , 20       NOTARY PUBLIC / CLERK & MASTER My Commission expires:       Small Estate Affidavit Page 4 of 2 CERTIFICATE I, Clerk and Master for the ____________________________ Court of ____________________________ County, certify that this is a court of record; that this is a true, full, and correct copy of the Small Estate Affidavit filed in this Court; that this Affidavit is still in full force and effect as of this date; and that the original of this Affidavit is on file in the office of the Clerk and Master for ____________________________ County, Tennessee. Witness my hand and seal, this ______ day of ___________________, 20___. _____________________________________ COURT CLERK & MASTER By: _____________________________ Deputy Clerk BOND: ________________________ ________________________________ CLERK & MASTER Small Estate Affidavit Page 5 of 2 NOTE: Bond shall be made for the total value of the estate as shown above, provided however that bond may be waived by a Judge of the Probate Court if all heirs at law request in writing that the bond be waived for the affiant. Since the will is not being proved and therefore is not admitted to Probate, a waiver requested by the will cannot be granted. The affiant and the sureties on the affiant's bond may obtain discharge from liability under the bond in either of two (2) ways: (A) The court may enter an order discharging the affiant and the sureties on the affiant's bond after the affiant files: (i) Either the tax receipt issued pursuant to § 67-8-420, or the certificate issued pursuant to § 67-8-409; and (ii) An affidavit that each debt of the decedent is paid. (B) Instead of filing as provided in subdivision (A), the affiant and the sureties on the affiant's bond may wait until the first anniversary of the filing of the affidavit when the court shall automatically discharge them from liability. Small Estate Affidavit Page 6 of 2 WAIVER OF BOND FOR SMALL ESTATE AFFIDAVIT I, ________________________ , state that I am the ________________________ of ________________________ , Deceased, and I hereby consent to the appointment of ________________________ , as the Affiant of the Estate and I request that said Affiant serve without the requirement of making a bond. Signed: ________________________ Address: ________________________ Phone: ________________________ Date: ________________________ STATE OF ________________________ COUNTY OF ________________________ Sworn to and Subscribed before me this ______ day of ________________________ , 20 ______ . ___________________________ Notary Public My Commission Expires: ________ _____________ Small Estate Affidavit Page 7 of 2