Form Approved for Optional Use
L
-0169 [New February 14, 2019]
DECLARATION OF WRITTEN ASSURANCE
Probate Code § 3401
www.occourts.org
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address)
TELEPHONE NO.:
E-MAIL ADDRESS (Optional):
ATTORNEY FOR (Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE
STREET ADDRESS:
700 Civic Center Drive West
MAILING ADDRESS:
700 Civic Center Drive West
CITY AND ZIP CODE:
BRANCH NAME:
DECLARATION OF WRITTEN ASSURANCE
I, , the parent of, , a minor,
declare that I am entitled to custody of the minor and that the total estate of the minor does not
exceed five thousand dollars ($5,000) in value.
I acknowledge I am required to hold the money or other property in the minor’s estate in trust
for the minor’s benefit, and to account to the minor for the management of the money or other
property when the minor reaches the age of majority.
This declaration is a written assurance to the person making the payment of money or delivery
of other property pursuant to Probate Code section 3401.
I declare under penalty of perjury under the laws of the State of California that the foregoing
is true and correct.
Date: ____________________
____________________________
____________________________
