Riverside — Notice to Public Entities (RI-PR054)

Source: https://www.riverside.courts.ca.gov/system/files/ri-pr054.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-PR054 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 PUBLIC ENTITIES

Probate Code §§ 9200-9201, 19201 – Government Code § 811.2

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

   a. Decedent’s Name:

   b. Date of Death:

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

   a. Name:

   b. Address:

   c. Telephone:

   d. Capacity: Estate Attorney, Personal Representative, Trustee

3. A case has been opened for claims to be filed under Probate Code § 9201 or 19201 as follows:

   a. Case Name:

   b. Case Number:

   c. SUPERIOR COURT OF CALIFORNIA, COUNTY OF Riverside

   STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME:

4. If you have a claim against the above-mentioned estate(s), please forward documentation to the address indicated in item 2

   above.

Date: (SIGNATURE OF PARTY PROVIDING NOTICE)

Approved for Optional Riverside Superior Court Use NOTICE TO PUBLIC ENTITIES ProbateGovernmentCode §§Code9200-9201§ 811.2 RI-PR054 [Rev.02/26/14] Probate Code §§ 9200-9201, 19201 – Government Code § 811.2 riverside.courts.ca.gov(Reformatted 12/23/24)

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 Public Entities by enclosing a copy in an envelope addressed to:

   Employment Development Department Post Office Box 826880 Sacramento, CA 94280-0001

   State Board of Equalization Post Office Box 942879 Sacramento, CA 94279-0001

   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 information above is true and correct.

Date: (SIGNATURE OF DECLARANT)

Approved for Optional Riverside Superior Court Use NOTICE TO PUBLIC ENTITIES ProbateGovernmentCode §§Code9200-9201§ 811.2 RI-PR054 [Rev. 02/26/14] Probate Code §§ 9200-9201, 19201 – Government Code § 811.2 riverside.courts.ca.gov(Reformatted 12/23/24)