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NOT A COURT FILED FORM

DECLARATION FOR TRANSFER OF SMALL ESTATES WITHOUT PROBATE (Probate Code § 13100 et seq.)

Heir(s) hereby declare:

1. I am the successor in interest of decedent (name

   of decedent), who died in (County), California on (date).

2. At least 40 days have elapsed since the death of the decedent, as shown in a certified copy of the decedent’s death certificate attached to this declaration. California Probate Code § 13101(a)(3).

3. No proceeding is now being or has been conducted in California for Administration of the decedent’s estate, California Probate Code § 13101(a)(4).

4. The current gross fair market value of the decedent’s real and personal property in California, excluding the property described in California Probate Code § 13050, does not exceed one hundred and sixty-six thousand two hundred and fifty dollars ($166,250.00) if decedent died before April 1, 2022, or one hundred eighty-four thousand five hundred dollars ($184,500.00) if decedent died on or after April 1, 2022.

5. The property of the decedent that is to be paid, transferred or delivered to the declarant(s) is as follows: (LIST THE PROPERTY, INCLUDING ACCOUNT NUMBERS FOR FINANCIAL ACCOUNTS, V.I.N. AND LICENSE NUMBERS FOR AUTOMOBILES.)

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6. Heir(s) are the successor of the decedent as provided in California Probate Code §

13006(a)(7) and 13101(a)(7).

7. The declarant(s) are the successors of the decedent (as defined in California Probate

   Code § 13006) to the decedent’s interest in the described property. California Probate Code §13101(a)(3)(b). The decedent died intestate, leaving no surviving, and the declarants are all of the children of the decedent.

   [OR]

   The declarants are all of the beneficiaries entitled to receive property under the

   decedent’s Will, a copy of which is attached.

Not A Court Filed Form DECLARATION FOR TRANSFER OF SMALL ESTATES Page 1 of 2 PR-01 (Adopted 01/01/12, WITHOUT PROBATE (Probate Code § 13100 et seq.) Revised 01/01/24)