San Luis Obispo — PR021

Source: https://www.slo.courts.ca.gov/documents/san-luis-obispo/PR_021_SLO.pdf

ATTORNEY OR PARTY WITHOUT ATTORNEY (NAME, STATE BAR NUMBER AND ADDRESS) FOR COURT USE ONLY

TELEPHONE NUMBER: FAX NO. (Optional):

EMAIL ADDRESS (Optional):

ATTORNEY FOR (Name):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN LUIS OBISPO

STREET ADDRESS: 1035 Palm Street, Room 385 MAILING ADDRESS: Same as above CITY AND ZIP CODE: San Luis Obispo, CA 93408 BRANCH NAME: San Luis Obispo Division

ESTATE OF: CASE NUMBER:

NOTICE TO FRANCHISE TAX BOARD Probate Code § 9202 (c)

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

   a. Decedent’s Name:_____________________________________________________________.

   b. Date of Death:________________________________________________________________.

   c. Social Security Number:_________________________________________________________.

2. A copy of the decedent’s death certificate is attached.

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

   a. Name:_______________________________________________________________________.

   b. Address:_____________________________________________________________________.

   c. Telephone:___________________________________________________________________.

   d. Capacity: Estate Attorney Personal Representative.

4. If you have a claim against the above mentioned estate, please forward documentation to the

address indicated in item 3 above.

Date:_____________________ ____________________________________________ (Signature of party providing notice)

Form Adopted for Optional Use NOTICE TO FRANCHISE TAX BOARD Probate Code § 9202(c)San Luis Obispo Superior Court Local Form PR021 Probate Code §9202 Rev. 1/1/15

Insert case name: CASE NUMBER

PROOF OF SERVICE

1. I am over the age of 18 and am not a party to this case. I live or work in the county where the
mailing occurred.

2. My (the servers) home or business address is as follows:

3. I served the foregoing NOTICE OF ADMINSTRATION, FRANCHISE TAX BOARD by enclosing a
copy in an envelope addressed to:

Franchise Tax Board
P.O. Box 2952, MS A-454
Sacramento, California 95812-9974

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

I declare under penalty of perjury under the laws of the State of California that the information
above is true and correct.

_________________ ________________________________ ___________________________
(Date signed) (Print Name) (Signature)

Form Adopted for Optional Use NOTICE TO FRANCHISE TAX BOARD Probate Code § 9202(c)San Luis Obispo Superior Court Local Form PR021 Probate Code §9202 Rev. 1/1/15