Michigan Affidavit of Death
Michigan Affidavit of Death
Introduction
I, [YOUR NAME], being duly sworn on oath, depose and state as follows:
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I am over the age of eighteen (18) and am of sound mind.
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I reside at [YOUR ADDRESS], in the County of [COUNTY NAME], State of Michigan.
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I am making this Affidavit in connection with the death of [DECEASED'S NAME], who passed away on [DATE OF DEATH].
Statement of Facts
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[DECEASED'S NAME], the deceased, was born on [DATE OF BIRTH] and was a resident of [DECEASED'S ADDRESS].
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The deceased was insured under a life insurance policy issued by [INSURANCE COMPANY NAME], policy number [POLICY NUMBER].
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I am familiar with the terms of the life insurance policy and know that it provides for the payment of benefits upon the death of the insured.
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To the best of my knowledge, the deceased did not revoke or otherwise modify the life insurance policy before their death.
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I am aware that I am named as the beneficiary of the life insurance policy and am entitled to receive the benefits under the policy.
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I have attached a copy of the death certificate of the deceased, issued by the [ISSUING AUTHORITY].
Sworn Oath
I do solemnly swear that the foregoing statements are true and correct to the best of my knowledge, information, and belief.
[YOUR NAME]
Affiant
Sworn to and subscribed before me on this [DATE] day of [MONTH], [YEAR].
Notary Public
My Commission Expires: [EXPIRATION DATE]
[NOTARY SEAL]
