RECORDING REQUESTED BY
WHEN RECORDED MAIL TO
Title Order No.
SPACE ABOVE THIS LINE FOR RECORDER'S USE
AFFIDAVIT - DEATH
(Probate Code 13200, et al)
STATE OF CALIFORNIA
COUNTY OF ________________________________________
_________________________________________________________________the affiant, being first duly sworn, deposes an says:
 Decedent owned the following described property
 That decedent ______________________________ died on _______________________ as evidenced by a certified copy of the
Certificate of death attached hereto;
 That the gross value of real property is less than $10,000;
 That six months or more have expired since the date of death of decedent;
 That affiant is the successor to the estate of the decedent (as defined in Section 13006 of the Probate Code) and to the decedents
interest in the described property, and no other person has a superior right to the interest of the decedent in the described roperty;
 That the name and address of each person serving as guardian or conservator of the estate of the decedent at the time of the
decedent's death, so far as known to the affiant,
 That no proceeding is no being or has been conducted in California for administration of the decedent's estate;
 That the funeral expenses, expenses of last illness, and all unsecured debts of decedent have been paid.
The affiant declares under penalty of perjury under the law of California that the foregoing is true and correct. That affiant will testify,
declare, depose, or certify before any tribunal, officer, or person, in any case now pending or which may thereafter be instituted, to the
trust of the particular facts, hereinabove set forth.
A notary public or other officer completing this certificate verifies only the
identity of the individual who signed the document to which this certificate
is attached, and not the truthfulness, accuracy, or validity of that document.
State of California
County of ____________________________________
SUBSCRIBED AND SWORN TO (or a rmed before me on this _____________ day of
_________________________ 20____________ by___________________________________________________________
proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me.
Notary Signature ___________________________________________ (seal)