NOT A COURT FILED FORM DECLARATION FOR TRANSFER OF SMALL ESTATES WITHOUT PROBATE (Probate Code § 13100 et seq.) Heir(s) hereby declare: 1. I am the successor in interest of decedent who died in (date). (name of decedent), (County), California on 2. At least 40 days have elapsed since the death of the decedent, as shown in a certified copy of the decedent's death certificate attached to this declaration. California Probate Code § 13101(a)(3). No proceeding is now being or has been conducted in California for Administration of the decedent's estate, California Probate Code § 13101(a)(4). The current gross fair market value of the decedent's real and personal property in California, excluding the property described in California Probate Code § 13050, does not exceed one hundred thousand dollars ($100,000.00) 3. 4. 5. The property of the decedent that is to be paid, transferred or delivered to the declarant(s) is as follows: (LIST THE PROPERTY, INCLUDING ACCOUNT NUMBERS FOR FINANCIAL ACCOUNTS, V.I.N. AND LICENSE NUMBERS FOR AUTOMOBILES.) _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ 6. Heir(s) are the successor of the decedent as provided in California Probate Code § 13006(a)(7) and 13101(a)(7). The declarant(s) are the successors of the decedent (as defined in California Probate Code § 13006) to the decedent's interest in the described property. California Probate Code §13101(a)(3)(b). The decedent died intestate, leaving no surviving, and the declarants are all of the children of the decedent. [OR] The declarants are all of the beneficiaries entitled to receive property under the decedent's Will, a copy of which is attached. 8. No person has a superior right to the interest of the decedent in the described property. California Probate § 13101(a)(9). 7. Not A Court Filed Form PR-01 (Adopted 01/01/12) Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com NOT A COURT FILED FORM DECLARATION FOR TRANSFER OF SMALL ESTATES WITHOUT PROBATE (Probate Code § 13100 et seq.) 9. The declarant(s) request that the described property be paid, delivered or transferred to the declarants, California Probate §13101(a)(10). I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct, and that this declaration was executed on: Date: , at California. (California Probate Code § 13101(a)(11). (Type or print your name) (Signature of Heir 1) (Type or print your name) (Signature of Heir 2) NOTARY ACKNOWLEDGEMENT STATE OF CALIFORNIA, COUNTY OF (specify): _________________________________________________ On (date): ______________________ before me (name and title): __________________________________ Personally appeared name: __________________________________________________________________ Who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he/she executed the same in his/her authorized capacity, and that by his/her signature on the instrument the person, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing is true and correct. (NOTARY SEAL) WITNESS my hand and official seal. _____________________________ Signature of Notary Public Not A Court Filed Form PR-01 (Adopted 01/01/12) Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com