(a) To collect money, receive tangible personal property, or have evidences of a debt, obligation, interest, right, security, or chose in action transferred under this chapter, an affidavit or a declaration under penalty of perjury under the laws of this state shall be furnished to the holder of the decedent’s property stating all of the following:

1. (1) The decedent’s name.
2. (2) The date and place of the decedent’s death.
3. (3) “At least 40 days have elapsed since the death of the decedent, as shown in a certified copy of the decedent’s death certificate attached to this affidavit or declaration.”

4. (4) Either of the following, as appropriate:

   1. (A) “No proceeding is now being or has been conducted in California for administration of the decedent’s estate.”
   2. (B) “The decedent’s personal representative has consented in writing to the payment, transfer, or delivery to the affiant or declarant of the property described in the affidavit or declaration.”
5. (5) “The current gross fair market value of the decedent’s real and personal property in California, excluding the property described in Section 13050 of the California Probate Code and any property included in a petition filed under Section 13151 of the California Probate Code, does not exceed [Insert dollar amount specified in subdivision (g) of Section 13101 of the California Probate Code].”
6. (6) A description of the property of the decedent that is to be paid, transferred, or delivered to the affiant or declarant.
7. (7) The name of the successor of the decedent, as defined in Section 13006, to the described property.

8. (8) Either of the following, as appropriate:

   1. (A) “The affiant or declarant is the successor of the decedent (as defined in Section 13006 of the California Probate Code) to the decedent’s interest in the described property.”
   2. (B) “The affiant or declarant is authorized under Section 13051 of the California Probate Code to act on behalf of the successor of the decedent (as defined in Section 13006 of the California Probate Code) with respect to the decedent’s interest in the described property.”
9. (9) “No other person has a superior right to the interest of the decedent in the described property.”
10. (10) “The affiant or declarant requests that the described property be paid, delivered, or transferred to the affiant or declarant.”
11. (11) “The affiant or declarant affirms or declares under penalty of perjury under the laws of the State of California that the foregoing is true and correct.”

(g)

1. (1) If the decedent dies prior to April 1, 2022, the dollar amount for paragraph (5) of subdivision (a) is one hundred sixty-six thousand two hundred fifty dollars ($166,250).
2. (2) If the decedent dies on or after April 1, 2022, the dollar amount for paragraph (5) of subdivision (a) is the adjusted dollar amount, published in accordance with subdivision (c) of Section 890, in effect on the date of the decedent’s death.