Riverside local form RI-PR112

Source: https://www.riverside.courts.ca.gov/system/files/2026-03/RI-PR112.pdf

SUPERIOR COURT OF CALIFORNIA, COUNTY OF RIVERSIDE

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

PALM SPRINGS 3255 E. Tahquitz Canyon Wy., Palm Springs, CA 92262 RI-PR112

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 DEPARTMENT OF CHILD SUPPORT SERVICES Probate Code § 9202(e)

1. You are hereby given notice of the death of the following person: a. Decedent’s Name:

   b. Decedent’s date of birth:

   c. Decedent’s date of death:

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

3. Notice is being provided for you to determine if the decedent had a child support obligation under an order issued by a court of competent jurisdiction.

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

   b. Address:

   c. Telephone:

   d. Email:

   d. Capacity: Estate Attorney, Personal Representative

5. The local child support agency providing services pursuant to Division 17 (commencing with Section 17000) of the Family Code may assert a claim against decedent’s estate no later than four months after receiving this notice, as provided in Probate Code 9202(e).

Date: (PARTY PROVIDING NOTICE)

Approved for Optional Riverside Superior Court Use NOTICE TO DEPARTMENT OF CHILD SUPPORT SERVICES Probateriverside.courts.ca.govCode §9202(e) RI-PR112 [New 01/14/26] Probate Code §§ 9202(e)

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 DEPARTMENT OF CHILD SUPPORT SERVICES by enclosing a copy in an envelope

   addressed as shown below and depositing the sealed envelope on the date and at the place shown in item 4 with the United States Postal Service with the postage fully prepaid.

   Department of Child Support Services P.O. Box 419064 Rancho Cordova, CA 95741-9064

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: (SIGNATURE OF DECLARANT)

Approved for Optional Riverside Superior Court Use NOTICE TO DEPARTMENT OF CHILD SUPPORT SERVICES Probateriverside.courts.ca.govCode § 9202(e) RI-PR112 [New 01/14/26] Probate Code § 9202(e)