____________________________________________________,  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 ________________________________________________________, the transferor under the Revocable Transfer on Death Deed dated ________________ and recorded on _________________ as Instrument No. ______________   in Book/Reel ______________, Page/Image  _____________, of the Official Records of ______________________________ County, California, which named as beneficiary(ies) _________________________________ ____________________________________________________________________________   and which transferred the following described property in   ____________________________  County, California: (insert legal description)

Dated ____________________ 	____________________________________________
					(Signature of declarant)	

					____________________________________________
					(Type or print name of declarant)	

AFFIDAVIT – DEATH OF TRANSFEROR 
(REVOCABLE TOD DEED)

Assessor’s Parcel Number (APN): __________________

Recording requested by (name):
________________________________________

And when recorded, mail this deed and tax statements to (name and address): 
________________________________________

________________________________________

________________________________________

________________________________________

For recorder’s use

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 _____________, 20___, by _________________________________________________________________,
proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me..

Signature ___________________________________     (Seal)