Affidavit for Collection of Real and Personal Property Pursuant to California Probate Code §13100-13116 I, 1. in the County of , state as follows: (name of decedent), died on , California. (date of death) 2. At least 40 days have passed since the death of the decedent, as shown by the attached certified copy of the decedent's death certificate. 3. No proceeding is now being or OR has been conducted in California for administration of the decedent's estate. 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 value of the decedent's real and personal property in California, excluding the property described in Probate Code §13050, does not exceed $100,000.00. 5. An inventory and appraisement OR of the real property included in the decedent's estate is attached. There is no real property in the estate. 6. The following property is to be paid, transferred or delivered to the undersigned according to Probate Code § 13006 (describe the property to be transferred): 7. The successor(s) of the decedent, as defined in Probate Code § 13006 is/are: 8. I am: a successor(s) of the decedent OR to the decedent's interest in the described property. authorized under Probate Code §13051 to act on behalf of the decedent's successor(s) with respect to the decedent's interest in the described property. 9. No other person has a right to the interest of the decedent in the described property. 10. I request that the above-described property be paid, delivered or transferred to the undersigned. American LegalNet, Inc. www.FormsWorkflow.com Affidavit for Collection of Real and Personal Property Pursuant to California Probate Code §13100-13116 - continued I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date Sign Name Print Name (If more than one declarant is entitled to receive the described property, all need to sign this affidavit. If this is the case, additional declarants can sign below and on an additional page.) Date Date Date Date Sign Name Sign Name Sign Name Sign Name Print Name Print Name Print Name Print Name Acknowledgement (By Notary Public) State of California ) County of _____________________________ ) ) On _________________(date) before me, personally appeared ________________________ [1] who proved to me on the basis of satisfactory [2] 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 the 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:______________________________ Print Name: _______________________________ My commission expires: _______________________ (Seal) American LegalNet, Inc. www.FormsWorkflow.com