Name, Address and Telephone No. of Attorney(s) Space Below for Use of Court Clerk Only SUPERIOR COURT OF THE STATE OF CALIFORNIA FOR THE COUNTY OF ORANGE __________________________________________ In the Matter of the Petition of ………………………………………………………………………………… No. to establish the fact of death of DECREE ESTABLISHING FACT OF DEATH ………………………………………………………………………………… (Sec. 1170 Probate Code) _______________________________ Deceased The verified petition of the above named petitioner by _______________________________________________, attorney for said petitioner to establish the fact of death of above named deceased (life)( joint) tenant in the above entitled proceeding, in certain property, coming on regularly to be heard on ________________________________, 20____, in Department _______________________________, the Court, after examining the petition and hearing the evidence, and finding that all notice 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 ___________________________________, 20____. *Strike either the word “life” or “joint”. **State either: “has been paid as shown by receipt on file herein”, or “referee’s Certificate of No Tax is on file herein”, or “if any, will be determined in the probate proceedings”. L-0067 (R3/09) DECREE ESTABLISHING FACT OF DEATH American LegalNet, Inc. www.FormsWorkflow.com