AFFIDAVIT To comply with California Probate Code 24724713100-13115 SB-13100, Rev. 05-2014 AFFIDAVIT to comply with California Probate Code 247247 13100-13115 1.The undersigned hereby declare(s):2.[I/We] make this declaration to induce [holder of property] to transfer to [me/us] the described property pursuant toCalifornia Probate Code 24724713100-13115.3.[Name of decedent] died at , while a resident of the City of , County of , California, on or about ,20 , leaving [a/no] will.4.At least 40 days have elapsed since the death of the decedent, as shown in a certified copy of the decedent222s deathcertificate attached to this affidavit or declaration.5.No proceeding is now being or has been conducted in California for administration of the decedent222s estate.6.The current gross fair market value of the decedent222s real and personal property in California, excluding the propertydescribed in California Probate Code 24713050 does not exceed one hundred7.fifty thousand dollars ($150,000) and includes the following: [Describe the property to be transferred with sufficient detailto be identifiable.] 8.The affiant or declarant is the successor of the decedent [as defined in California Probate Code 24713006] to thedecedent222s interest in the described property.9.No other person has a superior right to the interest of the decedent in the described property.10.[My/Our] name(s), address(es), relationship(s) to the decedent and age(s) are as follows: [List]11.The affiant or declarant requests that the described property be paid, delivered, or transferred to the affiant or declarant.12.[I/We jointly and severally] agree to hold [property holder] free and harmless and indemnify [him/her] against all liability,claims, demands, loss, damages, costs and expense whatsoever that [he/she/it may incur because of the transfer,payment, or delivery to [me/us] of the property.13.The affiant or declarant affirms or declares under penalty of perjury under the laws of the State of California that theforegoing is true and correct.Dated: Signature: Dated: Signature: Subscribed and sworn to me before this day of , 20 My Commission expires on: Notary Public in and for said County and State American LegalNet, Inc. www.FormsWorkFlow.com