New Mexico Affidavit of Death

New Mexico Affidavit of Death

Introduction

I, [YOUR NAME], being of lawful age and sound mind, hereby depose and state as follows under penalty of perjury:

Statement of Facts

  1. I am the [RELATIONSHIP TO DECEASED], of the deceased, [DECEASED'S NAME], who passed away on [DATE OF DEATH], in [COUNTY NAME], New Mexico.

  2. The deceased was a resident of [COUNTY NAME], New Mexico, at the time of their death.

  3. The deceased was insured under policy number [INSURANCE POLICY NUMBER] with [INSURANCE COMPANY NAME], for which a claim is being made.

  4. The cause of death was [CAUSE OF DEATH], as certified by [CERTIFYING AUTHORITY].

Sworn Oath

I solemnly swear that the foregoing statements are true and correct to the best of my knowledge, information, and belief. I understand that any false statements made herein are subject to penalties for perjury.

Executed on this [DATE] day of [MONTH], [YEAR].

[YOUR NAME]

Affiant


Notary Acknowledgment

State of New Mexico

County of [COUNTY NAME]

Subscribed and sworn to before me this [DATE] day of [MONTH], [YEAR], by [YOUR NAME], who is personally known to me or who has produced [type of identification] as identification.

Notary Public

My Commission Expires: [EXPIRATION DATE]

[NOTARY SEAL]

Affidavit Templates @ Template.net