Arkansas Affidavit of Death

I, [Your Name], residing in [Your Address], being duly sworn, depose and state as follows:

Statement of Facts

1. I am of legal age and competent to make this affidavit.

2. I am the [Relationship to Deceased], with personal knowledge of the facts herein.

3. [Deceased's Name], departed from this life on [Date of Death], in the town of [Town Name], County of [County Name], State of Arkansas.

4. The death of [Deceased's Name] is duly recorded in the vital records of the State of Arkansas.

5. [Deceased's Name]'s Social Security Number is [Social Security Number].

6. A copy of the death certificate issued by the Arkansas Department of Health is attached hereto as Exhibit A.

Sworn Oath

I hereby affirm under penalty of perjury that the foregoing statements in this Affidavit of Death are true and correct to the best of my knowledge.

Signature

[Your Name]
Affiant

Subscribed and sworn to before me this [Day] day of [Month], [Year].

[Notary Public's Name]

Notary Public for the State of Arkansas

My Commission Expires: [Expiry Date]

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