Approved for Option al Use L - 0 169 ( Creat ed 02 - 2019 ) DECLARATION OF WRITTEN ASSURANCE Probate Code 247 3401 www.occourts.org ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address) FOR C O U R T U SE O N L Y TELEPHONE NO.: FAX NO. (Optional) : E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE STREET ADDRESS: 700 Civic Center Drive West MAILING ADDRESS: 700 Civic Center Drive West CITY AND ZIP CODE: Santa Ana, CA 92701 - 4045 BRANCH NAME: Central Justice Center CASE TITLE: CASE NUMBER DECLARATION OF WRITTEN ASSURANCE I, , the parent of, , a minor, declare that I am entitled to custody of the minor and that the total estate of the minor does not exceed five thousand dollars ($5,000) in value. I acknowledge I am required to hold the money or other property in the minor222s estate in trust for the minor222s benefit, and to account to the minor for the management of the money or other property when the minor reaches the age of majority. This declaration is a written assurance to the person making the payment of money or delivery of other property pursuant to Probate Code section 3401. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: ( TYPE OR PRINT NAME ) ( SIGNATURE OF DECLARANT ) American LegalNet, Inc. www.FormsWorkFlow.com