Affidavit for Collection of Personal Property
Under California Probate Code §§ 13100–13106

The undersigned state(s) as follows:
1.	___[name of deceased person]___ died on ___[date of death]___ in the County of ___[county of death]___, State of California.
2.	At least 40 days have elapsed since the death of the decedent, as shown by the attached certified copy of the decedent’s death certificate.
3.	No proceeding is now being or has been conducted in California for administration of the decedent’s estate.
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 $166,250.
5.	[  ] An inventory and appraisal of the real property included in the decedent’s estate is attached.  OR
	[  ] There is no real property in the estate.
6.	The following property is to be paid, transferred, or delivered to the undersigned under the provisions of California Probate Code Section 13100. 
______________________[property description]________________________
7.	The successor(s) of the decedent, as defined in Probate Code Section 13006, is/are:
_____________[name(s) of new owner(s)]_____________
8.	The undersigned
	[  ] is/are successor(s) of the decedent to the decedent’s interest in the described property, or
	[  ] is/are authorized under California Probate Code Section 13051 to act on behalf of the successor(s) of the decedent 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 undersigned request(s) that the described property be paid, delivered, or transferred to the undersigned.
I/We declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Dated:	_________________________, 20____
	________________________________ 	________________________________
Signature					Address
Dated:	_________________________, 20____
	________________________________ 	________________________________
Signature					Address

Certificate of Notary Public
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 	  

Subscribed and sworn to (or affirmed) before me on this _____ day of _____________________, 20_____, by _________________________, proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me. 

		Signature 
	[SEAL]