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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