Missouri Affidavit of Death
MISSOURI AFFIDAVIT OF DEATH
I, [YOUR NAME], being duly sworn, depose and state as follows:
STATEMENT OF FACTS
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I am of legal age and competent to make this affidavit.
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[DECEASED PERSON'S NAME] (hereinafter referred to as the "Decedent") departed from this life on [DATE OF DEATH], in the County of [COUNTY NAME], State of Missouri.
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The Decedent was a resident of [CITY/TOWN NAME], County of [COUNTY NAME], State of Missouri, at the time of their death.
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The Decedent's Social Security Number was [SOCIAL SECURITY NUMBER] and their date of birth was [DATE OF BIRTH].
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The Decedent is survived by [SURVIVING RELATIVES], as listed in the attached document enumerating heirs.
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An official copy of the Decedent's death certificate, denoted as Exhibit A, is appended hereto, and I affirm its accuracy and authenticity.
SWORN OATH
I solemnly affirm, under penalty of perjury, that the foregoing statements are true and correct to the best of my knowledge and belief.
SIGNATURE
[Your Name]
Affiant
Subscribed and sworn to before me this [Day] day of [Month], [Year].
[Notary Public's Name]
Notary Public for the State of Missouri
My Commission Expires: [Expiry Date]
