Pennsylvania Affidavit of Death

Introduction

I, [YOUR NAME], being duly sworn according to law, depose and state as follows:

• I am over the age of eighteen (18) years and competent to make this Affidavit.

• I make this Affidavit in connection with the death of [DECEASED'S NAME], who passed away on [DATE OF DEATH], as evidenced by the attached copy of the Death Certificate.

• The purpose of this Affidavit is to transfer ownership of the vehicle described below from the deceased to the rightful heir or beneficiary.

Statement of Facts

1. The deceased, [DECEASED'S NAME], was the registered owner of the following vehicle:

   • Year: [VEHICLE YEAR]

   • Make: [VEHICLE MAKE]

   • Model: [VEHICLE MODEL]

   • Vehicle Identification Number (VIN): [VIN NUMBER]

   • License Plate Number: [LICENSE PLATE NUMBER]

2. I am familiar with the circumstances surrounding the death of the deceased and can confirm that he/she is deceased.

3. The vehicle was owned solely by the deceased at the time of his/her death, and no other person or entity has a legal claim to ownership of the vehicle.

Sworn Oath

I swear under penalty of perjury that the statements made in this Affidavit are true and correct to the best of my knowledge, information, and belief. I understand that any false statements made in this Affidavit may subject me to criminal penalties.

[YOUR NAME]

Affiant

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Sworn to and subscribed before me this [DATE] day of [MONTH], [YEAR].

Notary Public, State of Pennsylvania

My commission expires: [EXPIRATION DATE]

[NOTARY SEAL]

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