Affidavit for Collection of Personal Property
California Probate Code Section 13100

The undersigned state(s) as follows:

1.                                                      died on                            , 20     , in the County of                      , State of California. 

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 or declaration. 

3. 	   No proceeding is now being or has been conducted in California for administration of the decedent's estate. 
				OR
	  The decedent's personal representative has consented in writing to the payment, transfer, or delivery to the affiant or declarant of the property described in the affidavit or declaration.

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 sixty-six thousand two hundred fifty dollars ($166,250) if decedent died before April 1, 2022 or one hundred eighty-four thousand five hundred dollars ($184,500) if decedent died on or after April 1, 2022.

5.	   An inventory and appraisal of the real property included in the decedent’s estate is attached.
	  There is no real property in the estate.

6. The following property to be transferred, delivered, or paid to the affiant under the provisions of California Probate Code section 13100:
                                                                                                                                                                           
                                                                                                                                                                           
                                                                                                                                                                           
                                                                                                                                                                           
7. The successor(s) of the decedent, as defined in Probate Code Section 13006 is/are:
                                                                                                                                                                           
                                                                                                                                                                           
8. The undersigned
	  The affiant or declarant is the successor of the decedent (as defined in Section 13006 of the California Probate Code) to the decedent's interest in the described property.
	  The affiant or declarant is authorized under Section 13051 of the California Probate Code to act on behalf of the successor of the decedent (as defined in Section 13006 of the California Probate Code) with respect to the decedent's interest in the described property.

9. No other person has a superior right to the interest of the decedent in the described property.

10. The affiant or declarant requests that the described property be paid, delivered, or transferred to the affiant or declarant.

The affiant or declarant affirms or declares under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Dated:                         

Signed: 
_________________________________________
_________________________________________
_________________________________________

ACKNOWLEDGMENT

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 _________________________)

On _________________________ before me, __________________________________________ 
							(insert name and title of the officer)

personally appeared ________________________________________________________________ who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.

WITNESS my hand and official seal.

Signature ___________________________________     (Seal) 

NOTARY SEAL

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 ________________________

On _______________, 20____, before me,  ___________________________________, a notary public, personally appeared ___________________________________, who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are  subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. 
I certify under PENALTY OF PERJURY under the laws of 
the State of California that the foregoing paragraph is true and correct.
WITNESS my hand and official seal.
____	______________________________________
	Signature of Notary