Recording Requested By: When recorded mail document to: NAME ADDRESS CITY STATE & ZIP Above Space for Recorder's Use Only AFFIDAVIT ­ DEATH OF JOINT TENANT State of California County of _______________________________} ss. ________________________________________, of legal age, being first duly sworn, deposes and says: That _______________________________________, the decedent mentioned in the attached certified 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/Reel __________, Page/Image ____________, of Official Records of __________________________________County, California, covering the following described property situated in the ___________________________________ ________________________, County of ________________________________________, State of California: That the value of all real and personal property owned by said decedent at date of death, including the property above described, did not then exceed the sum of $_________________________________________ Dated___________________________________ 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 the truthfulness, accuracy, or validity of that document. ____________________________________ State of California County of _______________________________} ss. 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 persons(s) who appeared before me. ___________________________________________ (SEAL) Notary Signature American LegalNet, Inc. www.FormsWorkFlow.com