CA affidavit

The undersigned state(s) as follows:

1. _____________________________________________ died on __________, 20____, in the County of _____________________________________, State of California.

2. At least 40 days have elapsed since the death of the decedent, as shown in a copy of the decedent's death certificate attached to this affidavit or declaration.

4. The current gross fair market value of the decedent's real and personal property in California, excluding the property described in Section 13050 of the California Probate Code, does not exceed one  hundred fifty thousand dollars ($150,000).

5. (   ) An inventory and appraisal of the real property included in the decenent's estate is attached.

• (   ) There is no real property in the estate.

6. The following property to be transferred, delivered, or paid to the affiant under the provisions of California Probate Code section 13100:

7. The successor(s) of the decedent, as defined in Probate Code Section 13006 is/are:

8. The undersigned

• (   ) the affiant or declarant is the succecssor of the decedent (as defined in Section 13006 of the California Probate Code) with respect to the decedent's interest in the described property.
• (   ) The affiant or declarant is authorized under Section 13051 of the California Probate Code to act on behalf of the successor of the decedent (as defined in Section 13006 of the California Probate Code) with respect to the decedent's interest in the described property.

9. No other pserson has a superior right to the interest of the decedent in the described property.

10. The affiant or declarant requests that the described property be paid, delivered, or transferred to the affiant or declarant.

The affiant or declarant affirms or declares under penalty or perjury under the laws of the State of California that the foregoing is true and correct.

Dated: ________________________

Signed:

__________________________________________________

__________________________________________________

__________________________________________________

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personally appeared ______________________________________________________________________________________ who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he /she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument

I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.

WITNESS my hand and official seal.

Signature __________________________________________________ (Seal)