HomeMy WebLinkAbout2703 (Complete Doty if no spouse or issus swvived the deceased.) 1
fC~ompteM in all roses) ~pwo• c 2:~. 2:st ~
t. The deceased is survived by: 3. The deceased
a. ? a spouse. ®no spouse. a. ? had no predeceased spouse. ~
b. ~ children, ? no children. b. ®had a predeceased spouse whose heirs are
c. ~ issue of predeceased ? no issue of pre- named in the list of heirs.
Children, deceased children.
d. ? parents. ?X n0 parents. (Complete only i~ no potent or rssu! survived the deceased) i
- 4. The deceased is survived by:
2, ®No surviving child or issue of a predeceased a. ®a brother or sister or issue of a predeceased
child has been omitted Irom the list of heirs. brother or sister and none ha_s bean anitted
from the list of heirs.
• _ - b. n no brother or sister or issue of a predeceased ~
• - - • - - brother aS.sister, - " ;
• ~ - F
_ -
INTESTATE List of heirs.
® (TESTAl~E) List of heirs. devisees and legatees. ? ( ~ ~ ~ -
• ~ Name and Address • - Relotionshi ~~e_ . ~
.t
•See Attached _ - •
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ADDITIONAL FACTS CONCERNING THE INDEPENDENT ADMINISTRATION OF ESTATE
,fit Decedents will does not preclude independent administration of this estate under Prob C 591 et seq.
~ U Decedent died intestate. _ .
~ Attach odditiorwl sheer{s/, it necesso•y~
Dated: January 25, 1979 ~
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s The foregoing is true of my own knowledge, except as to those matters which are therein stored upon information or-
belief, and os to those matters 1 believe the some to be true.
=i
~certifr (or declare) under penalty of perjury that the
~ 5{6NATOBE OE Arf I1~NT
foregoing is true and correct.
Subscribed and sworn to before me ,California
Executed at Anaheim
19 19._l4
this aY
o
Norory Public in and fa Cour;ty of
State of ~ r r
:f (7ECUT£D OY tS~DE Of CAIIrONN~?. TN IS MUST DE SW ONN TO sEf ONE • NOT?11? OR SiN ~L OfFICE4 ISEC. 2013.5~C
C(P~1A c~~''j
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