Riverside local form RI-PR012

Source: https://www.riverside.courts.ca.gov/system/files/local-forms/ri-pr012.pdf

RI-PR012 Declaration for Collection or Transfer of Small Estate without Administration under Probate Code 13101

The undersigned state(s) as follows:

1. died on at
   (Decedent’s Name) (Date of Death) (City and State)

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. The following section applies (check one): No proceeding is now being or has been conducted in the State of 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 or declarant of the property described below.

4. The current gross fair market value of the decedent’s real and personal property in California, excluding the property described in Probate Code 13050 and any property included in a Petition to Determine Succession filed under Probate Code Section 13151, does not exceed; (check one) $166,250 if the decedent died before April 1, 2022, $184,500 if the decedent died on or after April 1, 2022, and before March 31, 2025, $208,850 if the decedent died on or after April 1, 2025

5. The following property is to be paid, transferred or delivered to the undersigned under the provisions of California Probate Code Section 13100 (please describe the property in below space):

6. The successor(s) of the decedent, as defined in California Probate Code Section 13006, is/are:

7. The undersigned (please check which box(es) applies): Is successor(s) of the decedent to the decedent’s interest in the described property, or Is 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;

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

9. The undersigned request 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.

(DATE)

(TYPE OR PRINT NAME OF PARTY MAKING DECLARATION) (SIGNATURE)

(TYPE OR PRINT NAME OF PARTY MAKING DECLARATION) (SIGNATURE)

Additional Signature(s) Attached)

Approved for Optional Riverside Superior Court Use Declaration for Collection or Transfer of Small Estate without Probatehttps://riverside.courts.ca.govCode §§13100 - 13116 Form RI-PR012 [Rev. 03/12/25] Administration under Probate Code 13101

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)