Petition To Establish Fact Of Death
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Petition To Establish Fact Of Death Form. This is a California form and can be use in Yuba Local County.
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Tags: Petition To Establish Fact Of Death, PR05011, California Local County, Yuba
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number, and address)
TELEPHONE NO:
ATTORNEY FOR (NAME):
FOR COURT USE ONLY
FAX NO:
SUPERIOR COURT OF CALIFORNIA
COUNTY OF YUBA
215 FIFTH STREET, SUITE 200
MARYSVILLE, CA 95901
(530) 749-7600
IN THE MATTER OF THE PETITION OF:
TO ESTABLISH THE FACT OF DEATH OF:
CASE NUMBER:
PETITION TO ESTABLISH FACT OF DEATH
[H&S § 103450]
The undersigned respectfully alleges:
1.
Petitioner is a resident of the County of Yuba, State of California.
2.
Petitioner seeks to establish the fact of death of ___________________________, said death having
occurred _______________
in the County of __________________________, State of
__________________________, or in the Country of
.
3.
Said death has not been registered in conformity with the provisions of law in effect at the time of
said death, or such record has been lost or destroyed after having been filed.
WHEREFORE, Petitioner prays that an order of the Court be made establishing the fact of death of
_________________________ which occurred as set forth hereinabove, and for such other relief as the Court
deems proper.
Dated: ____________________
...................................
___________________________________
Type or Print Name
Signature of Petitioner
VERIFICATION
I declare under penalty of perjury the laws of the State of California that the foregoing is true and correct.
Dated: ____________________
...................................
___________________________________
Type or Print Name
Yuba County Superior Court
Effective 8/10/05
Signature of Petitioner
PETITION TO ESTABLISH FACT OF DEATH
[H&S § 103450]
PR05011
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