New Hampshire Affidavit of Death

STATE OF NEW HAMPSHIRE

COUNTY OF [County Name]

Introduction:

I, [YOUR NAME], of [YOUR ADDRESS], sworn under oath, declare:

Statement of Facts:

1. The deceased, [Deceased's Name], was born on [Date of Birth] and sadly passed away on [Date of Death].

2. The death occurred in [City/Town, State Name].

3. This affidavit is prepared in connection with the death of [Deceased's Name] to formally document these details for legal and administrative purposes.

4. I am the [Relationship to Deceased] of the aforementioned deceased and have personal knowledge of the facts herein.

5. This Affidavit of Death is executed for the purpose of informing [Pension Plan Name/Government Agency/Private Company] regarding the death of [Deceased's Name] to adjust benefits, terminate services, or any other necessary action as per the policies of [Pension Plan Name/Government Agency/Private Company].

6. Attached Documentation:

   • Attached hereto is a certified copy of the Death Certificate of [Deceased's Name].

Statement of Truth:

I affirm that the information provided in this affidavit is true and correct to the best of my knowledge.

Further Action:

I request that [Pension Plan Name/Government Agency/Private Company] take the necessary actions as per their policies and procedures in light of the deceased’s passing.

DATED this [Day] of [Month], [Year].

Signature:

[YOUR NAME]

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

[NOTARY PUBLIC NAME]

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