SMALL ESTATE AFFIDAVIT STATE OF CALIFORNIA COUNTY OF MARIN I, Dorian Mayhew Rothschild, upon oath state: a) b) c) d) My mailing address

is: 60 Arthur St., San Rafael, CA, 94901. My residential address is: 60 Arthur St., San Rafael, CA, 94901. I am a successor of the decedent's estate and am at or over the age of majority and am legally competent in all respects to make this affidavit. I am the executor of the decedents will.

DECEDENT'S INFORMATION: 1. The decedents full name is: Ryan Daniel Jagger 2. The date of the decedents death was March 13, 2012. 3. The decedent's place of death was: Tiburon, California. a) I have attached a certified copy of the death certificate. 4. At least 30 days have elapsed since the death of the decedent. 5. The decedent's place of residence immediately before his death was: 35 Palm Circle Dr., Terra Linda, California, 95422. 6. No letters of office are now outstanding on the decedents estate, and no petition for the appointment of a personal representative has been granted or is pending in California or in any other State to my knowledge. 7. This court has jurisdiction in this matter, because the Decedent resided in this State prior to death DECEDENT'S ESTATE VALUE: The gross value of the Decedent's entire estate including real property, wherever located and including contents of a safe deposit box but excluding liens and encumbrances, does not exceed $99,000.00. DECEDENT'S FUNERAL EXPENSES: All of the decedent's funeral expenses have been paid. MEDICAID ESTATE RECOVERY ACT: All money owed, if any, to the Department of Health and Human Services as a result of payment for benefits for Medicaid have been paid or provided for. DECEDENT'S CREDITOR CLAIMS: There is no known unpaid claimant or contested claim against the decedent, except as stated in the section entitled "Decedent's Funeral Expenses." DECENDENT DIED:
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The Decedent died with a will (testate) which was dated February 15, 2011. a. Affiant has made a diligent search for wills and codicils of the Decedent and to the best knowledge of Affiant, the will dated February 15, 2011 and codicil(s) dated _________________ accompanying this affidavit is the decedents last will, and Affiant knows of no later will or codicil(s) and said will came into affiants possession in the following manner: Prior to Decedent's death he gave Affiant his original will. b. A copy of the decedent's will should be filed with the Clerk of Probate Court in the County of Marin. c. A certified copy or the original will is on file with this Court. d. The names and places of residence of any surviving spouse, domestic partner, living minor child(ren), and living adult child(ren) of the decedent are as follows: Marth Rose Jagger Wife 35 Palm Circle Dr. Corte Madera, California, 95422 Portion of Estate: Martha Jagger shall receive all of Ryan Daniel Jagger's estate, including all real property and all tangible and intangible personal property. e. To the best of my knowledge and belief, the will on file is the Decedent's last will and was signed by the Decedent [and the attesting witnesses] as required by law and would be admissible to this Court. The names and places of the residence of the beneficiaries named under the will are as follows: Marth Rose Jagger Wife Minors Age: 0 35 Palm Circle Dr. Corte Madera, California, 95422 Portion of Estate: Martha Jagger shall receive all of Ryan Daniel Jagger's estate, including all real property and all tangible and intangible personal property. f. Affiant is not aware of any dispute or potential conflict as to the will of the Decedent.

LIST OF ASSETS IN THE DECEDENT'S ESTATE 1. DECEDENT'S PERSONAL PROPERTY TO BE DISTRIBUTED: The Decedent has no personal property to distribute. 2. DECEDENT'S REAL PROPERTY TO BE DISTRIBUTED: The Decedent has no real property to distribute. 3. DECEDENT'S MOTOR VEHICLES: The Decedent has no motor vehicles to distribute. DECLARATIONS OF AFFIANT:
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I have given written notice, by personal service or by certified mail, indentifying my claim and describing the property claimed, to every person whose right to succeed to the Decedent's property is equal or superior to mine, and at least 14 days have elapsed since the notice was served or mailed. I further acknowledge and understand that filing a false affidavit may constitute a felony in this state. I declare under penalty of perjury under the laws of the State of California that the foregoing document is true and correct to the best of my knowledge, information, and belief. EXECUTED this _____ day of _____________________, 20_____. SIGNATURE OF AFFIANT

______________________________ Dorian Mayhew Rothschild STATE OF CALIFORNIA COUNTY OF Marin On ____________________ before me, ________________________________, personally appeared _________________, proved to me on the basis of satisfactory evidence to be the person(s) whose name is subscribed to the within Affidavit and acknowledged to me that he/she executed the same in his/her authorized capacity, and who, being first duly sworn on oath according to law, deposes and says that he/she has read the foregoing Affidavit subscribed by him/her, and that the matters stated herein are true to the best of his/her information, knowledge and belief. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal.

________________________________________ (Notary Seal) Signature of Notary Public

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