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Notice To Victim Compensation And Government Claims Board RI-PR039 - California
| Notice To Victim Compensation And Government Claims Board Form. This is a California form and can be used in Probate Riverside Local County . |
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SUPERIOR COURT OF CALIFORNIA, COUNTY OF RIVERSIDE PALM SPRINGS 3255 E. Tahquitz Canyon Way, Palm Springs, CA 92262 RIVERSIDE 4050 Main St., Riverside, CA 92501 RI-PR039 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar Number and Address) FOR COURT USE ONLY TELEPHONE NO.: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO. (Optional): IN THE MATTER OF: CASE NUMBER: NOTICE TO VICTIM COMPENSATION & GOVERNMENT CLAIMS BOARD Probate Code §§ 216, 9202(b) 1. You are hereby given notice of the death of the following person: a. b. 2. 3. Decedent's Name: Date of Death: A copy of the decedent's death certificate is attached. At the time of the decedent's death or during the administration of the decedent's estate, the following heirs or beneficiaries of the decedent's estate were incarcerated in a facility identified in Probate Code § 216 or § 9202 (b): NAME LOCATION OF INCARCERATION DATE OF BIRTH CDCR or BOOKING NUMBER 4. The party providing you with this notice is as follows: a. b. c. d. Name: Address: Telephone: Capacity: Estate Attorney, Beneficiary, property of the Decedent, Trustee Personal Representative, Person in possession of 5. This notice is being provided by a personal representative, trustee, or the attorney who represents a personal representative or trustee. If you have a claim against the above-mentioned estate or trust, please forward documentation to the address indicated in item 4 above within the period provided by law. Date: (PARTY PROVIDING NOTICE) Page 1 of 2 Approved for Optional Use Riverside Superior Court RI-PR039 [Rev. 12/1/12] NOTICE TO VICTIM COMPENSATION & GOVERNMENT CLAIMS BOARD Probate Code §§ 216, 9202(b) Probate Code §§ 216, 9202(b) riverside.courts.ca.gov/localfrms/localfrms.shtm American LegalNet, Inc. www.FormsWorkFlow.com IN THE MATTER OF: CASE NUMBER: PROOF OF SERVICE BY MAIL 1. 2. I am over the age of 18 and am not a party in this cause. I am a resident of or employed in the county where the mailing occurred. My (the servers) home or business address is : (STREET ADDRESS) (CITY, STATE, ZIP) 3. I served the forgoing NOTICE TO VICTIM COMPENSATION AND GOVERNMENT CLAIMS BOARD by enclosing a copy in an envelope addressed to: Victim Compensation and Government Claims Board Revenue Recovery and Accounting Division P.O. Box 1348 Sacramento, California 95812-1348 and depositing the sealed envelope with the United State Postal Service with the postage fully prepaid. 4. Date mailed: , Place mailed (city,state): I declare under penalty of perjury under the laws of the State of California that the information above is true and correct. Date: (SIGNATURE OF DECLARANT) Page 2 of 2 Approved for Optional Use Riverside Superior Court RI-PR039 [Rev. 12/1/12] NOTICE TO VICTIM COMPENSATION & GOVERNMENT CLAIMS BOARD Probate Code §§ 216, 9202(b) Probate Code §§ 216, 9202(b) riverside.courts.ca.gov/localfrms/localfrms.shtm American LegalNet, Inc. www.FormsWorkFlow.com
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