Affidavit For Withdrawal Of Account Or Personal Property Form

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AFFIDAVIT FOR WITHDRAWAL OF ACCOUNT OR PERSONAL PROPERTY 
 
State of ____________________ 
County of ___________________ 
 
 
________________________ first being duly sworn (if plural, each affiant deposes for himself 
or herself and not for the other and all references to the singular include the plural), deposes and says: 
 
1. That ______________________________ died in the City of _____________, County of 
_____________________, on the ________ of ________, ______. 
 
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 affidavit. 
3.  Check one of the following, as appropriate: 
[     ]  No proceeding is now being 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 to the affiant of the property described in this     
                      affidavit. 
4.  The current gross fair market value of the decedent’s real and personal property in  
     California, excluding the property described in Section 13050 of the California Probate 
     Code, does not exceed one hundred fifty thousand dollars ($150,000). 
5.  The property of the decedent that is to be paid, transferred or delivered by Commonwealth Business 
     Bank to the affiant is described as follows:
 
 
[     ]  Money on deposit in Bank in Account No. ___________ in the sum of 
                      ______________________ Dollars ($________________). 
 
[     ]   Personal property situated in safe deposit box numbered __________ described 
                      as follows: _________________________________ 
 
           ________________________________________________________ 
 
           _______________________________________________________ 
 
 
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