Introduction

I, [YOUR NAME], hereby declare and affirm under penalty of perjury, as the lawful beneficiary of the estate of [DECEASED PERSON'S NAME], that the following statements are true and accurate to the best of my knowledge:

Statement of Facts

1. [DECEASED PERSON'S NAME], born on [DECEASED PERSON'S BIRTH DATE], and died on [DECEASED PERSON'S DEATH DATE], passed away in [CITY NAME], [STATE NAME].

2. The total value of [DECEASED PERSON'S NAME]'s estate, including real and personal property, does not exceed the statutory limit for a small estate as defined by California law.

3. As the lawful beneficiary of [DECEASED PERSON'S NAME], I am entitled to claim personal property belonging to the estate.

4. I understand and acknowledge that by signing this affidavit, I assume responsibility for the lawful distribution of the estate's assets and indemnify and hold harmless any entity releasing assets to me in reliance upon this affidavit.

5. I further certify that no other person has a superior right to the assets described herein, and I agree to indemnify and hold harmless the financial institution or entity releasing the assets from any claims or liabilities arising from the distribution of said assets.

6. I request that you release the aforementioned personal property to me, in accordance with California law, based on the representations made in this affidavit.

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Executed on [DATE] at [CITY NAME], [STATE NAME].

Signature

[YOUR NAME]

Beneficiary

[NOTARY PUBLIC NAME]

[NOTARY PUBLIC COMMISSION NUMBER]

[NOTARY PUBLIC EXPIRY DATE]

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