(a)To collect salary or other compensation under this chapter, an affidavit or a declaration under penalty of perjury under the laws of this state shall be furnished to the employer of the deceased spouse stating all of the following:
(1)The name of the decedent.
(2)The date and place of the decedent’s death.
(3)Either of the following, as appropriate:
(A)“The affiant or declarant is the surviving spouse of the decedent.”
(B)“The
affiant or declarant is the guardian or conservator of the estate of the surviving spouse of the decedent.”
(4)“The surviving spouse of the decedent is entitled to the earnings of the decedent under the decedent’s will or by intestate succession and no one else has a superior right to the earnings.”
(5)“No proceeding is now being or has been conducted in California for administration of the decedent’s estate.”
(6)“Sections 13600 to 13605, inclusive, of the California Probate Code require that the earnings of the decedent, including compensation for unused vacation, not in excess of [Insert dollar amount specified in subdivision (e) of Section 13601 of the California Probate Code] net, be paid promptly to the affiant or
declarant.”
(7)“Neither the surviving spouse, nor anyone acting on behalf of the surviving spouse, has a pending request to collect compensation owed by another employer for personal services of the decedent under Sections 13600 to 13605, inclusive, of the California Probate Code.”
(8)“Neither the surviving spouse, nor anyone acting on behalf of the surviving spouse, has collected any compensation owed by an employer for personal services of the decedent under Sections 13600 to 13605, inclusive, of the California Probate Code except the sum of ____ dollars ($____) that was collected from ____.”
(9)“The affiant or declarant requests that the affiant or declarant be paid the salary or other compensation owed by you
for personal services of the decedent, including compensation for unused vacation, not to exceed [Insert dollar amount specified in subdivision (e) of Section 13601 of the California Probate Code] net, less the amount of ____ dollars ($____) that was previously collected.”
(10)“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.”
(b)Where the decedent is a firefighter or peace officer described in subdivision (a) of Section 22820 of the Government Code, the affidavit or declaration need not include the content specified in paragraphs (6) to (9), inclusive, of subdivision (a). The affidavit shall instead include the following statements:
(1)“The decedent was a firefighter or peace officer described in subdivision (a) of Section 22820 of the Government Code. Sections 13600 to 13605, inclusive, of the California Probate Code require that the earnings of the decedent, including compensation for unused vacation, be paid promptly to the affiant or declarant.”
(2)“The affiant or declarant requests to be paid the salary or other compensation owed by you for personal services of the decedent, including compensation for unused vacation.”
(c)Reasonable proof of the identity of the surviving spouse shall be provided to the employer. If a guardian or conservator is acting for the surviving spouse, reasonable proof of the identity of the guardian or conservator shall also be provided to the employer. Proof of
identity that is sufficient under Section 13104 is sufficient proof of identity for the purposes of this subdivision.
(d)If a person presenting the affidavit or declaration is a person claiming to be the guardian or conservator of the estate of the surviving spouse, the employer shall be provided with reasonable proof, satisfactory to the employer, of the appointment of the person to act as guardian or conservator of the estate of the surviving spouse.
(e)(1) When the decedent dies prior to April 1, 2022, the dollar amount for paragraphs (6) and (9) of subdivision (a) is sixteen thousand six hundred twenty-five dollars ($16,625).
(2)When the decedent dies on or after April 1, 2022, the dollar amount
for paragraphs (6) and (9) 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. The affiant or declarant shall attach the list of adjusted dollar amounts, published in accordance with subdivision (c) of Section 890, in effect on the date of the decedent’s death to the affidavit or declaration.