ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, address and telephone #): FOR COURT USE ONLY STATE BAR NO: ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF MARIN 3501 Civic Center Drive P.O. Box 4988 San Rafael, CA 94913-4988 IN THE MATTER OF THE PETITION TO ESTABLISH THE FACT OF DEATH OF: DECEASED: JUDGMENT ESTABLISHING FACT OF DEATH (PROBATE CODE § 1170) CASE NUMBER: The verified petition of by ___________________________________________, his her attorney(s) to establish fact of death of deceased, heard on life joint tenant(s) in the above entitled proceeding, in certain property, coming on regularly to be . The court, after examining the petition and hearing the evidence, and finding that all notices of said hearing have been duly given as required by law, and that the facts alleged in said petition are true, and that the inheritance tax* grants said petition as follows: IT IS ORDERED, adjudged and decreed that said died on . *State either: "Has been paid as shown by receipt on file herein." or "Appraiser's Certificate of No Tax is on file herein." or "If any, will be determined on the probate proceedings." (OVER) PR008WB (Rev. 7/07) JUDGMENT ESTABLISHING FACT OF DEATH Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com Name: Case Number: The property affected by the death (s) of the decedent(s) is described as follows: Date: _________________________________ JUDGE OF THE SUPERIOR COURT PR008WB (Rev. 7/07) JUDGMENT ESTABLISHING FACT OF DEATH Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com