Activities Of Daily Living Assessment {L-3016}

L - 0 758 Page 1 of 2 Form Adopted for Mandatory Use L - 0 758 [ Revised June 13 , 201 9 ] DECLARATION IN SUPPORT OF BOND WAIVER (LOCAL RULE 603.07) Orange County Local Rule 603.07 www.occourts.org ATTORNEY OR PARTY WITHOUT ATTORNEY : STATE BAR NO.: NAME: FIRM NAME: STREET ADDRESS: CITY: STATE: ZIP CODE: TELEPHONE NO.: FAX NO. : E - MAIL ADDRESS: ATTORNEY FOR (name): FOR COURT USE ONLY SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE CENTRAL JUSTICE CENTER 700 Civic Center Drive West Santa Ana, CA 92701 - 4045 IN THE MATTER OF: CASE NUMBER: DECLARATION IN SUPPORT OF BOND WAIVER (LOCAL RULE 603.07) HEARING DATE: DEPT. : TIME : I /We, (name of petitioner(s)) , request bond be waived for my/our appointment as personal representative of the estate. 1. The decedent is expected to owe the following taxes: State income tax: $ Fe deral income tax: $ Real and personal property tax: $ Total: $ 2. The decedent owes or might owe money to (list only unsecured debts or possible debts) : Name of Creditor Address Maximum Potential Liability Total: American LegalNet, Inc. www.FormsWorkFlow.com IN THE MATTER OF: CASE NUMBER: L - 0 758 [ Revised June 13 , 201 9 ] DECLARATION IN SUPPORT OF BOND WAIVER (LOCAL RULE 603.07) Page 2 of 2 3. The estate is expected to be: solvent insolvent 4. The efforts taken to obtain the above information were as follows: days Reviewed current utility bills Reviewed current property tax bills Reviewed bank statements for the last months Reviewed most recent income tax returns Other: I/We declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. (DATE) (TYPE OR PRINT NAME) (SIGNATURE OF PETITIONER ) (TYPE OR PRINT NAME) (SIGNATURE OR PETITIONER ) American LegalNet, Inc. www.FormsWorkFlow.com