Kansas Affidavit of Death

I, [YOUR NAME], residing at [YOUR ADDRESS], do hereby solemnly affirm and declare under penalty of perjury that I have personal knowledge of the death of [DECEDENT'S NAME] (hereinafter referred to as the "Decedent"), who passed away on [DECEDENT'S DEATH DATE].

Statements

I certify the following facts regarding the death of the Decedent:

1. The Decedent was a resident of [CITY NAME], KS.

2. The Decedent passed away on [DECEDENT'S DEATH DATE].

3. I have personal knowledge of the Decedent's death as a family member.

4. I understand that it is necessary to inform relevant government agencies about the Decedent's passing to facilitate the closure of accounts and termination of contracts.

5. I hereby request that the appropriate actions be taken to close any accounts or terminate contracts held by the Decedent with your agency.

6. I am aware that providing false information in this Affidavit is punishable by law.

I affirm that the statements made herein are true and correct to the best of my knowledge and belief.

Signatures

Dated this [DATE].

[YOUR NAME]

[WITNESS' NAME]

[NOTARY PUBLIC'S NAME]

Notary Public

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