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California Affidavit of Death

This affidavit is made in accordance with the laws of the State of California.

Affiant Information:

  • Name: ____________________________
  • Address: ____________________________
  • Phone Number: ____________________________

Decedent Information:

  • Name: ____________________________
  • Date of Birth: ____________________________
  • Date of Death: ____________________________
  • Last Known Address: ____________________________

Declaration:

I, ____________________________, the undersigned, declare that:

  1. The decedent named above is deceased.
  2. The date of death of the decedent is as specified above.
  3. The cause of death is not relevant to this affidavit.

Affiant Signature:

_____________________________________

Date: ____________________________

State of California

County of ____________________________

Subscribed and sworn to before me this ____ day of __________, 20__.

______________________________

Notary Public

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