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KATHLEEN CONNELL Controller of the State of California DECLARATION CONCERNING RESIDENCE Name of Decedent Date of Death Social Security Number The undersigned, under penalty of perjury, makes the following
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Controller of form state is the individual or entity responsible for ensuring the accuracy and completeness of the information reported on the form.
The person or entity designated as the controller of form state on the form is required to file it.
Controller of form state can be filled out by providing accurate and complete information about the individual or entity responsible for the form.
The purpose of controller of form state is to ensure accountability and transparency in reporting of information on the form.
The information that must be reported on controller of form state includes name, title, contact information, and signature of the individual or entity responsible for the form.
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