STATE OF _____________________ )
                                                              ) SS.
COUNTY OF ___________________ )

___________________________________ of legal age, being first duly sworn, deposes and says:

____________________________________, 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 community property with right of survivorship, recorded on _________________________ as Instrument No. _________________, Official Records of ___________________________ County, California, describing the following real property:

Dated: ____________________________              ___________________________________

SUBSCRIBED AND SWORN TO before me, the
undersigned, a Notary Public in and for said State,
this _______ day of ________________________

Signature_________________________________