DECLARATION PURSUANT TO CALIFORNIA PROBATE CODE SECTIONS 13100-13115 The undersigned, _____________________________________________(name of declarant), hereby declares: 1. I am the successor in interest of decedent _____________________________ (name of decedent), who died in ____________________ (County), California on _____________________. 2. At least 40 days have elapsed since the death of the decedent, as shown in a certified copy of the decedent's death certificate attached to this declaration. 3. [Check either of the following as appropriate:] No proceeding is now being or has been conducted in California for administration of the decedent's estate. [OR] The decedent's personal representative has consented in writing to the payment, transfer, or delivery of the property described in this declaration. 4. The current gross fair market value of the decedent's real and personal property in California, excluding the property described in California Probate Code Section 13050, does not exceed one hundred fifty thousand thousand dollars ($100,000). dollars ($150,000). 5. The following __________________________ (e.g. "account") constitutes a portion of the property in the decedent's estate: _________________________________________________________________ (describe property claimed by this declaration ­ e.g., "current balance in Savings Account No. 123-45678 at Main Street National Bank, Head Office, 123 Main Street, Santa Barbara, CA 93101"). 6. Decedent died without a will and, under Section 6402 of the California Probate Code, I am the decedent's sole heir at law and the "successor" of the decedent (as defined in Section 13006 of the California Probate Code) to the decedent's interest in the described property. [Modify appropriately if (i) the declarant is decedent's testate beneficiary of the described property or (ii) decedent died without a will and left more than one intestate heir, but declarant has the superior right under California Probate Code Section 6402 to inherit the described property.] 7. No other person has a superior right to the decedent's interest in the described property. 8. Pursuant to the facts set forth above and Sections 13100-13115 of the California Probate Code, I request that the above-described property be paid, delivered or transferred to me. 9. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. (Name) Declarant Dated: [Note: If more than one declarant is entitled to receive the described property, all should join in executing the declaration and the allegations should be modified to reflect the plural.] American LegalNet, Inc. SC-6021 [Rev. January 1, 2012] www.FormsWorkFlow.com