RECORDING REQUESTED BY
AND WHEN RECORDED MAIL DOCUMENT AND
TAX STATEMENT TO:
NAME
STREET
ADDRESS
CITY, STATE &
ZIP CODE
TITLE ORDER NO. ESCROW NO. SPACE ABOVE THIS LINE FOR RECORDER’S USE ONLY
APN:
AFFIDAVIT – DEATH OF JOINT TENANT
STATE OF
COUNTY OF
, of legal age, being first duly sworn, deposes and says:
That , the decedent mentioned in the attached certified copy of
Certificate of Death, is the same person as named as one of the
parties in that certain dated executed by
to
as joint
tenants, recorded as Instrument No. , on of the Official Records in the Office
of the County Recorder of County, State of , concerning
the following described real property situated in the City of , County of
, State of :
(Insert legal description)
That the value of all real and personal property owned by the decedent at the date of death, including the full value of
the above described real property, did not then exceed the sum of $ .
Dated this day of ,
(Signature of affiant)
(Type or print full name of affiant)
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to
which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of California
County of
Subscribed and sworn to (or affirmed) before me on this day of ,
by, , proved to me on the basis of satisfactory evidence to be the
person(s) who appeared before me.
(Signature)
(Seal)
* There are various types of deed forms depending on each person’s legal status. Before you use this form you may want to consult an
attorney if you have questions concerning which document form is appropriate for your transaction.
Rev. 1/01/16
