RECORDING REQUESTED BY: _____________________________________ WHEN RECORDED MAIL TO: Name:________________________________ Address:______________________________ City: _________________________________ State, Zip:_____________________________ Above Space for Recorder's Use Only AFFIDAVIT OF DEATH OF JOINT TENANT Assessor's Parcel Number: ____________________________ State of California County of _______________________________________________ } ss _______________________________________________________, of legal age, being first duly sworn, deposes and says: That ______________________________________________, the decedent mentioned in the attached certificate copy of Certificate of Death, is the same person as _____________________________________________________ named as one of the parties in that certain ___________________________________________________________ dated _______________,______________, executed by ______________________________________________________________________________________________ to ______________________________________________________________________________________________________, as joint tenants, recorded as Instrument No. ________________________________ on ___________________, _____________, in Book ____________________, Page _______________, of __________________Records of ____________________________ County, California, covering the following described property situated in the said County, State of California: _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ __________________________________________________ That the value of all real and personal property owned by the said decedent at date of death, including the full value of the property above described, did not then exceed the sum of $ _________________________ _______________________________________ Print Name ____________________________________ Signature A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not to the truthfulness, accuracy, or validity of that document. State of California County of ___________________________________ Subscribed and sworn to (or affirmed) before me on this _____day of _____, 20___, by__________________________, proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me. (Official SEAL) ___________________________________ Notary Signature ADJT (01/01/2015) American LegalNet, Inc. www.FormsWorkFlow.com