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I, [YOUR NAME], being duly sworn, depose and state as follows:
Statement of Facts
I am of legal age and competent to make this affidavit.
[DECEASED PERSON'S NAME] (hereinafter referred to as the "Decedent") passed away on [DATE OF DEATH], in the County of [COUNTY NAME], State of New York.
The Decedent was domiciled in [CITY/TOWN NAME], County of [COUNTY NAME], State of New York, at the time of their decease.
The Decedent's date of birth was [DATE OF BIRTH] as indicated in their birth certificate.
The Decedent is survived by their family and relatives, as set forth in the attached roster of heirs.
A true and complete copy of the Decedent's death certificate, identified as Exhibit A, is annexed hereto and hereby affirmed for its accuracy and genuineness.
It is hereby certified that the Decedent's estate has been duly administered and all outstanding obligations have been settled to the best of my knowledge.
Sworn Oath
I declare under penalty of perjury that the foregoing is true and correct to the best of my knowledge and belief.
Executed this [Day] day of [Month], [Year] at [Location].
Signature
[Your Name] Affiant
Subscribed and sworn to before me this [Day] day of [Month], [Year].
