Connecticut Affidavit of Death
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
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I am the [RELATIONSHIP OF DECEASED] of the deceased, [DECEASED'S NAME], who passed away on [DATE OF DEATH], in [COUNTY NAME], Connecticut.
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The deceased was a resident of [COUNTY NAME], Connecticut at the time of their death.
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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.
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To the best of my knowledge, information, and belief, the deceased did not leave a will or any other testamentary document.
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The deceased's estate consists of the following assets and liabilities, to the best of my knowledge and belief:
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[LIST OF ASSETS]
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[LIST OF LIABILITIES]
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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]
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]
