STATE OF CALIFORNIA

COUNTY OF [County Name]

Introduction:

I, [YOUR NAME], residing at [YOUR ADDRESS], City of [City Name], County of [County Name], State of California, declare under penalty of perjury under the laws of the State of California that the following is true and correct:

Statement of Facts:

1. The decedent, [Decedent's Name], resided at [Decedent's Address] at the time of death. The decedent passed away on [Date of Death], in the City of [City of Death], County of [County of Death], State of California.

2. I am the [Relationship to Decedent], of the decedent and am legally authorized to make this affidavit.

3. Attached to this affidavit is a certified copy of the decedent's death certificate.

4. The decedent owned certain property described as follows, which I am entitled to by:

a. Real Property: Located at [Address or Legal Description of the Property], County of [County Name], State of California.

b. Vehicle: [Make, Model, Year], VIN [Vehicle Identification Number].

c. Stocks: [Number and Type of Stocks], in [Corporation Name], Certificate Number [Certificate Number].

5. No proceeding is now being or has been conducted in California for administration of the decedent's estate.

6. I hereby claim the property described above and declare that this affidavit is made for the purpose of collecting the described property from the person or entity in possession of it.

Legal Declaration:

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

Executed this [Day] of [Month], [Year], at [City Name], California.

Signature:

[YOUR NAME]

[NOTARY PUBLIC NAME]

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