RI-PR012 AFFIDAVIT FOR COLLECTION OF PERSONAL PROPERTY The undersigned state(s) as follows: 1. (DECEDENT) died (DATE OF DEATH) in the County of Riverside, State of California; 2. 3. 4. 5. At least 40 days have elapsed since the death of the decedent, as shown by the attached certified copy of the decedent's death certificate; No proceeding is now being or has been conducted in the State of California for administration of the decedent's estate; The current gross fair market value of the decedent's real and personal property in California, excluding the property described in section 13050 of the California Probate Code, does not exceed $150,000.00; The following property is to be paid, transferred or delivered to the undersigned under the provisions of California Probate Code Section 13100 (please describe the property in below space): 6. The successor(s) of the decedent, as defined in California Probate Code Section 13006, is/are: 7. The undersigned (please check which box(s) applies): Is successor(s) of the decedent to the decedent's interest in the described property, or Is authorized under California Probate Code Section 13051 to act on behalf of the successor(s) of the decedent with respect to the decedent's interest in the described property; 8. 9. No other person has a superior right to the interest of the decedent in the described property; The undersigned request that the described property be paid, delivered or transferred to the undersigned. I/We 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 OF PARTY MAKING DECLARATION) (SIGNATURE) Approved for Optional Use Riverside Superior Court RI-PR012 [Rev.1/1/12] AFFIDAVIT FOR COLLECTION OF PERSONAL PROPERTY Probate Code§§ 13100 - 13116 riverside.courts.ca.gov/localfrms/localfrms.shtml Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com ACKNOWLEDGMENT Personally appeared who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature (Seal) Page 2 of 2 Approved for Optional Use Riverside Superior Court RI-PR012 [Rev. 1/1/12] AFFIDAVIT FOR COLLECTION OF PERSONAL PROPERTY Probate Code§§ 13100 13116 riverside.courts.ca.gov/localfrms/localfrms.shtml American LegalNet, Inc. www.FormsWorkFlow.com