Washington Affidavit of Death
Washington Affidavit of Death
Introduction
I, [YOUR NAME], being duly sworn, depose and state as follows:
Statement of Facts
-
I am over the age of eighteen (18) years and am of sound mind and competent to make this affidavit.
-
I am a resident of [CITY NAME], State of Washington, and have personal knowledge of the facts stated herein.
-
[DECEASED'S NAME], hereinafter referred to as the "Decedent," was a resident of [CITY NAME], State of Washington.
-
The Decedent passed away on [DATE OF DEATH] in [CITY NAME], State of Washington.
-
Attached hereto and incorporated herein as Exhibit A is a certified copy of the Decedent's death certificate issued by the Washington State Department of Health, which certifies the Decedent's death on the aforementioned date.
-
The Decedent was the insured under a life insurance policy issued by [INSURANCE COMPANY NAME], policy number [POLICY NUMBER].
-
The undersigned is a beneficiary under said life insurance policy and is entitled to claim the benefits thereunder.
Sworn Oath
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct.
Executed on [DATE OF EXECUTION] at [CITY NAME], State of Washington.
[YOUR NAME]
Affiant
Notary Acknowledgment
State of Washington
County of [COUNTY NAME]
Subscribed and sworn to before me on [DATE OF EXECUTION], by [YOUR NAME], proved to me based on satisfactory evidence to be the person(s) who appeared before me.
Notary Public in and for the State of Washington
My commission expires: [EXPIRATION DATE]
[NOTARY SEAL]
