Served by

,292a Civil Registry and

35 Identification
mtrtsteg -atke".
and Human Rights

Government of Chie

Form for Modification of Intestate Possessions before the Civil Registry and Identification
Service

OFFICE NRO. REQUEST FOR MOD. DATE

Cause Data
Run:
Paternal Surname Mother's Last Name Names

Applicant Data
Run:
Paternal Surname Mother's Last Name Names

Address: Commune:
Phone: E-mail:
Representative Data
Run:
Paternal Surname Mother's Last Name Names

Address: Commune:
Phone: E-mail address
Ajunta: Power or Mandate ___ Others _____ Notary ______________ ___ Date _______/ ______/ ______

This declaration is made according to the rules set forth in Law 16.271/65 Art.4
Law 19.903/03

4- If you need to "add" an asset that you have not considered in the main application, you must enter the
corresponding data and at the end enter: Add (A)

4- If you need to "correct" an existing asset in the main application, you must indicate in the first row the
wrong data and at the end set Delete (E), then in the second row, indicate the asset with the correct
data and finish with the action Add (A).

4- If you need to "eliminate" an asset that you have declared in the main application and it does not belong to
an asset left at the death of the deceased, you must indicate the asset that does not correspond and put
the action Eliminate (E).

Accept with Benefit of Inventory: Yes or NO

A1.- REAL ESTATE
Own (P) or Social
Agricultural (A) or
Non Agricultural

REGISTRATION IN THE REAL ESTATE

IBS ACTION
acquisition

REGISTRY
Date of
(NA)

(S)

VALUE
ROLE FOFAS NUMBER YEAR CONSERVATOR Delete (E) or
COMMUNE Add (A)
 Service
Civil Registry and Identification mintst- -ieiets and Human Rights

Government of Chile

B1.- VEHICLES
PPU SII CODE TYPE BRAND MODEL YEAR N°
IDENTIFICATION P/S EVALUATION Delete (E) or
Add (A)

B2.- MENAJE
Own or Delete (E) or
Description of the Property Valuation
Social Add (A)

C1.- REAL ESTATE EXCLUDED WITH TAX APPRAISAL

Reference Real Own or Delete (E) or
Description of the Property Valuation
Estate Social Add (A)

C2.- OTHER PROPERTY (Businesses, companies, rights, quotas, etc.)

Own or Delete (E) or
Description of the Property Valuation
Social Add (A)

C3.- OTHER ASSETS (Stocks, Securities, Deposits, Bonds)

Certificate Own or Delete (E) or
Description of the Property Institution Valuation
No. Social Add (A)

2.- CREDITED DEBTS

Delete (E) or
Description of Debt Creditor Valuation
Doc. o Certificate Add (A)

DECLARATION EXEMPT / SUBJECT TO INHERITANCE TAX

EXEMPT FROM ALL ALLOWANCES
AFFECT SOME OF THE ALLOCATIONS
ALL ASSIGNMENTS ARE AFFECTED
SIGNATURE CIVIL REGISTRY OFFICER SIGNATURE OF APPLICANT OR REPRESENTATIVE

NOTE: The Civil Registry Service will not be responsible if the content of the same has been modified.