Hawaii Affidavit of Death

I, [Your Name], being duly sworn, depose and state the following facts under oath:

Statement of Facts

1. [Deceased's Name], born on [Date of Birth], with Social Security number [Social Security Number], passed away on [Date of Death], in the city of [City Name], County of [County Name], State of Hawaii.

2. The death of [Deceased's Name] occurred due to [Cause of Death], as determined by [Name of Medical Authority], and I have personal knowledge of the circumstances surrounding their passing.

3. As the [Relationship to Deceased] of the deceased, I am familiar with their personal and legal affairs, and I am authorized to make this affidavit.

4. A death certificate issued by the vital records office in [County Name], Hawaii, has been obtained and confirms the death of [Deceased's Name]. A certified copy of the death certificate is attached hereto.

5. At the time of their death, [Deceased's Name] resided at [Deceased's Address] in [City Name], Hawaii. To the best of my knowledge, the deceased had no outstanding debts or legal obligations.

6. I understand the importance of this affidavit in providing formal notification and verification of the death of [Deceased's Name] for legal and administrative purposes.

Sworn Oath

I affirm that all statements made in this written affidavit are true and accurate to the best of my knowledge and belief.

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 Hawaii

My Commission Expires: [Expiry Date]

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