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
REVOCATION OF
REVOCABLE TRANSFER ON DEATH (TOD) DEED
(California Probate Code Section 5600)
ASSESSOR’S PARCEL NUMBER:
This deed revocation is exempt from documentary transfer tax under Revenue & Taxation Code 11930
This deed revocation is exempt from preliminary change of ownership report under Revenue & Taxation Code 480.3
IMPORTANT NOTICE: THIS FORM MUST BE RECORDED TO BE EFFECTIVE
This revocation form MUST be RECORDED before your death or it will not be effective. This revocation form only affects a transfer on
death deed that YOU made. A transfer on death deed made by a co-owner of your property is not affected by this revocation form. A
co-owner who wants to revoke a transfer on death deed that he/she made must complete and RECORD a SEPARATE revocation
form.
PROPERTY DESCRIPTION Print the legal description of the property affected by this revocation:
REVOCATION
I revoke any TOD deed to transfer the described property that I executed before executing this form.
SIGNATURE AND DATE Sign and print your name below (your name should exactly match the name shown on your title documents):
___________________________________ __________________________
Date Signature of Grantor
_________
Typed or Printed Name of Grantor
STATE OF _________________________________
COUNTY OF _______________________________
On ___________________________________ before me, ,
(Date) (Name and title of the officer)
personally appeared , who proved to me on the basis of
(Name of person signing)
satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they
executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity
upon behalf of which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.
WITNESS my hand and official seal.
_____________________________________________________________
Signature of officer
(Seal)
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.
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.
