Nebraska Small Estate Affidavit
This document is designed to help individuals manage the distribution of assets for estates that fall under the threshold specified by Nebraska’s Small Estates Act. This affidavit allows for the transfer of assets without formal probate proceedings. Before using this template, ensure the estate meets the criteria established by Nebraska Revised Statute 30-24,125.
Section 1: Deceased Information
Full Name of Decedent: ___________________________________________________
Date of Death: ___________________________________________________________
County of Death: __________________________________________________________
Last Address: _____________________________________________________________
Did the decedent have a Will? (Yes / No) ____________________________________
Section 2: Affiant Information
Full Name of Affiant: ______________________________________________________
Relationship to Decedent: __________________________________________________
Address: __________________________________________________________________
Phone Number: _____________________________________________________________
Email: ____________________________________________________________________
Section 3: Asset List
Below, list all assets you claim are subject to this affidavit. Include any financial accounts, personal property, real estate (if applicable), and other assets.
- Asset Description: ______________________________________________________
- Asset Description: ______________________________________________________
- Asset Description: ______________________________________________________
Section 4: Debts and Liabilities
List all known debts and liabilities of the decedent at the time of death.
- Debt/Liability: __________________________________________________________
- Debt/Liability: __________________________________________________________
- Debt/Liability: __________________________________________________________
Section 5: Declaration and Signature
I, the undersigned, hereby declare under penalty of perjury that the information provided in this affidavit is true and accurate to the best of my knowledge. I understand that this affidavit is made to facilitate the transfer of assets without a formal probate process, and I agree to indemnify and hold harmless any entities relying on this affidavit for the transfer of assets. I acknowledge that this affidavit does not serve as a substitute for a will and does not transfer title to real estate located outside of Nebraska.
Signature of Affiant: ____________________________________ Date: ________________
Printed Name: ___________________________________________
Notary Public
State of Nebraska)
)ss
County of ________________)
On this day, ________________ of ________________, 20____, before me,
______________________________________ (Notary public name), personally appeared
______________________________________ (Affiant name), known to me (or satisfactorily proven)
to be the person whose name is subscribed to in the foregoing affidavit, and acknowledged that they executed the same for the purposes contained therein.
Notary Signature: ____________________________________
Printed Name: ________________________________________
My Commission Expires: _______________________________