Affidavit of Death
This Affidavit of Death is prepared in accordance with state laws. This document serves to officially declare the death of an individual.
State: ________________________
County: ________________________
Affiant:
- Name: ________________________
- Address: ________________________
- Phone Number: ________________________
- Relation to Deceased: ________________________
Deceased:
- Name: ________________________
- Date of Birth: ________________________
- Date of Death: ________________________
- Last Known Address: ________________________
Statement of Facts:
- The affiant is of legal age and competent to make this affidavit.
- The deceased passed away on the date stated above.
- The affiant was present at the time of death, or has personal knowledge of the death.
- No other information contradicts this statement of death.
This affidavit is made for the purpose of:
- Settling estate affairs.
- Notification of relevant agencies.
- Obtaining death certificates or similar documents.
Signed this ______ day of ____________, 20___.
__________________________
Affiant Signature
__________________________
Printed Name of Affiant
Witnessed by:
__________________________
Signature of Witness
__________________________
Printed Name of Witness