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Any PetitionerAny StreetAny Town, CA 90000

555-555-5555

Petitioner, In Pro Per

Superior Court of the State of California

For the County of ________________

Estate of:

__________________________

Deceased.

)))))))))))))

Case No.

VERIFIED SUPPLEMENT TO PETITION FOR________________________________

DATE:TIME:DEPT:

Petitioner, __________________________, as the Petitioner in the above-

entitled action and as a supplement to the Petition for__________________, states as follows:

1. All items of property inventoried were the separate property of the Decedent.

Petitioner has prepared an Inventory and Appraisal along with attachments which was mailed to

the Probate Referee on ______________. Upon receipt of the completed Inventory and Appraisal

Petitioner will prepare, file and serve the Notice of Allowance or Rejection forms for the claims filed

by _____________ on ___________ and ____________ as Petitioner must have the amount of the

Inventory and Appraisal to complete said forms, DE-174.

2. Notice in the manner provided by Probate Code § 216 is not required to be given

- 1 -VERIFIED SUPPLEMENT TO ___________________________

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to the Director of the California Victim Compensation and Government Claims Board.

3. Due to an error ________________________________.

4. All claims paid as listed by the Petitioner were (1) justly due, (2) were paid in

good faith, (3) the amount paid was the true amount of the indebtedness over and above all payments

and offsets, and (4) the estate was solvent at the time the claims were paid. Said claims were paid

without a formal claim being filed. Said claims were to, __________________________.

5. All statements and figures in the reports and accounts filed with the Petition for

_____________ are true and correct. All statements made by the Petitioner in the Petition for

______________ are true and correct.

6.

Be sure to modify these paragraphs to suit your individual situation. Do NOT just

use the wording here unless it definitely applies to your particular situation. Be sure to list all

of the problems that were listed in the probate notes and what your explanation is, or list the

additional information that was requested in the probate notes. Be sure to file this supplement

with the Court at least one (1) week before the hearing, or as listed in the local rules of your

county.

Dated:_________________ _________________________________________ NAME OF PETITIONER,

PETITIONER

- 2 -VERIFIED SUPPLEMENT TO ___________________________

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VERIFICATION

I, the undersigned, the Petitioner for the above named case, declare that I have read the

foregoing Verified Supplement to Petition for ____________________________ and all attachments

and know its contents. I declare that the Verified Supplement to Petition for

____________________________, including all attachments, is true to my own knowledge, except

as to matters in it stated on my own information and belief, and as to those matters I believe it to be

true.

I declare under penalty of perjury under the laws of the State of California that the

foregoing is true and correct and that this declaration was executed on ________________,2011 at

_________, California.

_________________________________________

NAME OF PETITIONER

- 3 -VERIFIED SUPPLEMENT TO ___________________________