Riverside — Notice to Victim Compensation Board (RI-PR039)

Source: https://www.riverside.courts.ca.gov/system/files/ri-pr039.pdf

SUPERIOR COURT OF CALIFORNIA, COUNTY OF RIVERSIDE

MURRIETA 30755-D Auld Rd., Murrieta, CA 92563 RIVERSIDE 4050 Main Street, Riverside, CA. 92501

PALM SPRINGS 3255 E. Tahquitz Canyon Wy., Palm Springs, CA 92262 RI-PR039

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar Number and Address) FOR COURT USE ONLY

TELEPHONE NO.: FAX NO. (Optional):

E-MAIL ADDRESS (Optional):

ATTORNEY FOR (Name):

IN THE MATTER OF:

CASE NUMBER:

NOTICE TO VICTIM COMPENSATION BOARD Probate Code §§ 216, 9202(b) (Confidential)

1. You are hereby given notice of the death of the following person:

   a. Decedent’s Name: b. Date of Death:

2. A copy of the decedent’s Death Certificate is attached.

3. The following heirs or beneficiaries of the decedent’s estate are/were confined in a facility identified in Probate Code § 216 or § 9202 (b): LOCATION OF INCARCERATION OR CURRENT ADDRESS IF NO

NAME LONGER INCARCERATED DATE OF BIRTH CDCR or BOOKING NUMBER

4. The party providing you with this notice is as follows:

   a. Name:

   b. Address:

   c. Telephone:

   d. Capacity: Estate Attorney, Beneficiary/Heir, Personal Representative, Person in possession of of property of the Decedent, Trustee

5. This notice is being provided by a personal representative, trustee, or the attorney who represents a personal representative or trustee. If you have a claim against the above-mentioned estate or trust, please forward documentation to the address indicated in item 4 above within the period provided by law.

Date: (PARTY PROVIDING NOTICE)

Approved for Optional Riverside Superior Court Use NOTICE TO VICTIM COMPENSATION BOARD Probateriverside.courts.ca.govCode §§ 216, 9202(b) RI-PR039 [Rev. 01/14/26] Probate Code §§ 216, 9202(b)

IN THE MATTER OF: CASE NUMBER:

PROOF OF SERVICE BY MAIL

1. I am over the age of 18 and am not a party in this cause. I am a resident of or employed in the county where the mailing

   occurred.

2. My (the servers) home or business address is : (STREET ADDRESS) (CITY, STATE, ZIP)

3. I served the forgoing NOTICE TO VICTIM COMPENSATION BOARD by enclosing a copy in an

   envelope addressed to:

   Victim Compensation Board Revenue Recovery and Accounting Division P.O. Box 1348 Sacramento, California 95812-1348

   and depositing the sealed envelope with the United State Postal Service with the postage fully prepaid.

4. Date mailed: , Place mailed (city,state):

I 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) (SIGNATURE)

Approved for Optional Riverside Superior Court Use NOTICE TO VICTIM COMPENSATION BOARD Probateriverside.courts.ca.govCode §§ 216, 9202(b) RI-PR039 [Rev. 01/14/26] Probate Code §§ 216, 9202(b)