Affidavit of Death Template

This Affidavit of Death (the “Affidavit”) is made on [Date] by:

Affiant: [Full Name], address: [Address], phone/email: [Contact].
Relationship/Authority: ☐ Spouse ☐ Child ☐ Executor/Personal Representative ☐ Heir ☐ Attorney-in-fact ☐ Other: [Explain]

Decedent: [Full Legal Name]
Date of Birth (Optional): [DOB]
Date of Death: [Date]
Place of Death (City/State/Country): [City/State/Country]
Last Known Address: [Address]

1. Purpose

1.1 I am making this Affidavit to formally confirm the Decedent’s death for the following purpose(s):
☐ Bank/financial account update
☐ Insurance claim/benefit processing
☐ Lease/tenancy or landlord records
☐ Employer/benefits records
☐ Real estate title/record update
☐ Other: [Purpose]

2. Statement of Death

2.1 The Decedent named above died on [Date of Death] in [Place of Death].
2.2 A certified copy of the death certificate is: ☐ attached ☐ will be provided.

3. Property/Record Information (Optional)

3.1 Institution/Agency Receiving This Affidavit: [Name].
3.2 Account/Policy/Reference Number (Optional): [].
3.3 Real Estate (If Applicable): Property address: []. Parcel/Legal description (optional): [__].
3.4 Recording Information (If Known): [County recorder, instrument #, book/page].

4. Supporting Documents (Attach as Available)

4.1 ☐ Certified death certificate
4.2 ☐ Proof of identity of affiant
4.3 ☐ Letters testamentary/administration (if applicable)
4.4 ☐ Will (if applicable)
4.5 ☐ Marriage certificate (if spouse)
4.6 ☐ Property deed/title document (if applicable)
4.7 ☐ Other: [List]

5. Statement Under Oath

5.1 I declare under penalty of perjury that the statements in this Affidavit are true and correct to the best of my knowledge.

Signatures

Affiant: [Full Name]
Date: [Date]
Signature: ___________________________

Witnesses (If Required)

Witness Name: [Name]
Date: [Date]
Signature: ___________________________

Notary / Notarization (If Required)

State of [State]
County of [County]

On [Date], before me, [Notary Name], personally appeared [Affiant Full Name], known to me (or satisfactorily proven) to be the person whose name is subscribed to this Affidavit, and acknowledged that they executed it for the purposes stated.

Notary Public Signature: _______________________
My Commission Expires: _______________________
Notary Seal (if applicable): ___________________