Affidavit of Death
This Affidavit of Death is executed as per the laws of the State of [State Name]. This document serves to affirm the death of the individual named herein.
Affiant Information:
- Name: ___________________
- Address: ___________________
- Phone Number: ___________________
Deceased Information:
- Name: ___________________
- Date of Birth: ___________________
- Date of Death: ___________________
- Last Known Address: ___________________
Statement of Death:
I, [Affiant's Name], being duly sworn, state under oath that the following is true and correct:
- The individual named above is deceased.
- The date of death is as stated above.
- I have personal knowledge of the facts relating to the death of the deceased.
Affiant's Signature: ___________________
Date: ___________________
Witness Information:
- Name: ___________________
- Address: ___________________
- Signature: ___________________
- Date: ___________________
State of [State Name]
County of [County Name]
Subscribed and sworn before me on this _____ day of __________, 20____.
Notary Public: ___________________
My Commission Expires: ___________________