Form Sc 6021 – Fill Out and Use This PDF

DECLARATION PURSUANT TO

CALIFORNIA PROBATE CODE SECTIONS 1 3 1 0 0 -1 3 1 1 5

	The undersigned,					(nam e of declarant ), hereby declares:
1. I am t he successor in int erest of decedent								(nam e of decedent ), w ho died in
			(Count y), California on				.

2.At least 40 days have elapsed since t he deat h of t he decedent , as show n in a cert ified copy of t he decedent 's deat h cert ificat e at t ached t o t his declarat ion.

3. [Check eit her of t he follow ing as appropriat e:]

No proceeding is now being or has been conduct ed in California for adm inist rat ion of t he decedent 's est at e.

[OR]

The decedent 's personal represent at ive has consent ed in w rit ing t o t he paym ent , t ransfer, or delivery of t he propert y described in t his declarat ion.

4.The current gross fair m arket value of t he decedent 's real and personal propert y in California, excluding t he propert y described in California Probat e Code Sect ion 13050, does not exceed one hundred fiftyt housandthousanddollars

(dollars$100,000)($150,000)..

5. The follow ing			(e.g. "account ") const it ut es a p ort ion of t he p rop ert y in t he
d eced ent 's est at e:				(d escrib e

propert y claim ed by t his declarat ion – e.g., "current balance in Savings Account No. 123-45678 at Main St reet Nat ional Bank, Head Office, 123 Main St reet , Santa Barbara, CA 93101").

6. Decedent died w it hout a w ill and, under Sect ion 6402 of t he California Probat e Code, I am t he decedent 's sole heir at law and t he "successor" of t he decedent (as defined in Sect ion 13006 of t he California Probat e Code) t o t he decedent 's int erest in t he described propert y. [Modify appropriat ely if (i) t he declarant is decedent 's t est at e beneficiary of t he described propert y or (ii) decedent died w it hout a w ill and left m ore t han one int est at e heir, b ut d eclarant has t he sup erior right und er California Prob at e Cod e Sect ion 6402 t o inherit t he d escrib ed propert y.]

7.No ot her person has a superior right t o t he decedent 's int erest in t he described propert y.

8.Pursuant t o t he fact s set fort h above and Sect ions 13100-13115 of t he California Probat e Code, I request t hat t he above-described propert y be paid, delivered or t ransferred t o m e.

9.I declare under penalt y of perjury under t he law s of t he St at e of California t hat t he foregoing is t rue and correct .

(Nam e)
Declarant	Dat ed:

[Not e: If m ore t han one declarant is ent it led t o receive t he described propert y, all should join in execut ing t he declarat ion and t he allegat ions should be m odified t o reflect t he plural.]

SC-6021 [REV. January 1, 2012]	www.CalCourtForms.com