Affidavit of Death
This Affidavit of Death is prepared in accordance with the laws of the state of [State Name]. It serves as a formal document declaring the death of an individual.
Affiant Information:
- Name: _____________________________________________
- Address: ____________________________________________
- City, State, Zip: _____________________________________
- Phone Number: ________________________________________
Deceased Information:
- Name: _____________________________________________
- Address: ____________________________________________
- City, State, Zip: _____________________________________
- Date of Birth: _______________________________________
- Date of Death: _______________________________________
Statement of Death:
I, [Affiant's Name], being of sound mind, do hereby declare under penalty of perjury that the above-mentioned individual, [Deceased's Name], is deceased. I affirm that the information provided herein is true and accurate to the best of my knowledge.
Details surrounding the death are as follows:
- Place of Death: _______________________________________
- Cause of Death (if known): ____________________________
- Date of Death: _______________________________________
- Time of Death (if known): ____________________________
This Affidavit is made for the purpose of verifying the death of the individual named above and for all necessary legal purposes.
Signature: __________________________________________
Date: ______________________________________________
Sworn to and subscribed before me this _____ day of __________, 20__.
Notary Public: _____________________________________
My Commission Expires: __________________________