Connecticut Affidavit of Death

Introduction

I, [YOUR NAME], residing at [YOUR ADDRESS], do hereby affirm and declare my capacity to make this affidavit.

Statement of Facts

1. I am the [RELATIONSHIP OF DECEASED] of the deceased, [DECEASED'S NAME], who passed away on [DATE OF DEATH], in [COUNTY NAME], Connecticut.

2. The deceased was a resident of [COUNTY NAME], Connecticut at the time of their death.

3. Attached hereto and made a part hereof as Exhibit A is a true and correct copy of the death certificate of the deceased issued by the vital records office.

4. To the best of my knowledge, information, and belief, the deceased did not leave a will or any other testamentary document.

5. The deceased's estate consists of the following assets and liabilities, to the best of my knowledge and belief:

   • [LIST OF ASSETS]

   • [LIST OF LIABILITIES]

Sworn Oath

I solemnly swear under penalty of perjury that the foregoing statements are true and correct to the best of my knowledge, information, and belief.

[YOUR NAME]

Date: [DATE OF SIGNING]

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Notary Acknowledgment

State of Connecticut

County of [COUNTY NAME]

On this [DATE] day of [MONTH], [YEAR], before me, a Notary Public in and for said County and State, personally appeared [YOUR NAME], known to me to be the person whose name is subscribed to the within instrument, and acknowledged that he/she executed the same for the purposes therein contained.

Witness my hand and official seal.

Notary Public: [NOTARY PUBLIC NAME]

My Commission Expires: [EXPIRATION DATE]

[NOTARY SEAL]

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