FORM IT-2  
                                DECLARATION CONCERNING                                     RESIDENCE  
                                                     STATE CONTROLLER’S OFFICE  
                                LOCAL GOVERNMENT PROGRAMS AND SERVICES DIVISION  
                                                        BUREAU OF TAX PROGRAMS  
                                                               P. O. BOX 942850 
                                                      SACRAMENTO, CA 94250-5880 
                                                                         
            Name of Decedent                        Social Security Number                         Date of Death  

 The State Controller’s Office requires this form   to be completed        for the purposes   of establishing 
 residency for  the decedent.  These questions      are in accordance with the     Estate  Tax  Regulations,       section 
 1138.29 (Evidence of Intent).  This document must also           be completed  if the decedent    was     not   a California 
 resident and had  real or tangible personal   property    located in   California.  The undersigned,      under   penalty 
 of perjury, makes   the following  statements: 
  
 1. What    was the decedent’s legal residence at the date   of death?     (City and   State or  Country) 
   
      a.    Decedent’s   street address: 
                                                                                                                     
      b.    Type   ofabode maintained    at   that address (home,   apartment, hotel  room,  etc.)     
 
      c.    Did the decedent maintain    these quarters    while   in California?  (  )    Yes  (  )  No    
 
   2. Where was the decedent’s physical residence at the date of death? (City          and  state   or country) 
 
  3. Did   the decedent own   a home?          (     )  Yes   (     )  No  If yes, give city and state. 
 
   4. When and where  was the   decedent last      employed   or actively  engaged   in business? 
 
   5. When and where did the decedent last         vote? 
                                                      
   6. For  what year did the decedent last file   a federal income tax return? 

   7. Where and in   what state did the decedent    last file a   state income tax return?  
  
 Form IT-2                                                                                                 Rev. 12/2022  

  FORM IT-2  
                                   DECLARATION CONCERNING                                  RESIDENCE  
                                                       STATE CONTROLLER’S OFFICE  
                                   LOCAL GOVERNMENT PROGRAMS AND SERVICES DIVISION  
                                                          BUREAU OF TAX PROGRAMS  
                                                               P. O. BOX 942850 
                                                          SACRAMENTO, CA 94250-5880 
                                                                             
 8. Did   the decedent own an automobile?              (    )  Yes  (    )  No  If yes, in what state was    it   registered? 
 
 9. Did  the decedent    belong to a church,    lodge,   or other  social fraternal   or religious club   or organization 
    in California?       (    )  Yes    (    )  No.    If yes, give name and addresses   of such   clubs   or organizations. 
 
10. Did the decedent     spend   any time in California     in the  five years immediately   prior to his/her death?   
    (    )  Yes  (    )  No.    If yes, give the approximate dates,     addresses,  and  purpose   for being   in  California. 
 
11. Use the following space to give any additional information   in your            possession bearing upon the 
    questions   ofthe decedent’s   residence    at the date of death.     
 
 To the best   of my knowledge,      I declare,    under    penalty of   perjury,   that all the foregoing    is true and 
 correct. 
 
 Executor’s/Trustee’s  Name:  
                                                                                                                              
 Address:  
                                                                                                                              
 Signature:  

 Date:  

 Relationship to    decedent:  
                                                                                                                               
 Note:  Declaration    must   be notarized    if signed outside     the State   of California.(Rev. 12/2022) 

Form IT-2                                                                                                   Rev. 12/2022