CA Lab Code Section 5004

In case of death there shall also be stated in the release or compromise agreement:

(a)

The date of death.

(b)

The name of the widow.

(c)

The names and ages of all children.

(d)

The names of all other dependents.

(e)

Whether the dependents are total or partial.

(f)

The amount paid or to be paid as a death benefit and to whom payment is to be made.