Affidavit of Death Template
This affidavit is designed to serve as a formal declaration of an individual's death. It can be used to settle estates or resolve other legal matters related to the individual’s passing. This template is in accordance with relevant state laws.
Please fill in the following information where indicated:
- State of _____________
- County of _____________
- Date _____________
Affidavit of Death
I, [Affiant’s Full Name], being duly sworn, depose and say:
1. I am of legal age and am competent to testify to the matters stated herein.
2. I reside at [Affiant's Address], in [City, State, Zip Code].
3. I am making this affidavit to confirm the passing of:
- Deceased's Full Name: ___________________________
- Date of Birth: ______________________________
- Date of Death: ______________________________
- Place of Death: ____________________________
4. The deceased individual's death was certified by [Name of Certifying Authority], and the death certificate is attached as Exhibit A.
5. To the best of my knowledge, the deceased's last known address was:
- [Deceased's Address] ____________________________
6. I affirm that this affidavit is made for the purpose of establishing the fact of death for all legal intents and purposes.
7. I declare under penalty of perjury that the foregoing is true and correct.
Signed on this _____ day of ____________, 20__.
Signature of Affiant: _______________________________
Printed Name of Affiant: __________________________
Subscribed and sworn to before me this _____ day of ____________, 20__.
Notary Public: ____________________________________
My Commission Expires: ___________________________