Utah Affidavit of Death

STATE OF UTAH

COUNTY OF [COUNTY NAME]

Introduction:

I, [YOUR NAME], residing at [YOUR ADDRESS], being duly sworn, depose and say:

Statement of Facts:

1. The deceased, [Deceased's Name], was born on [Deceased's Date of Birth] and passed away on [Deceased's Date of Death].

2. The death occurred in [City/County Name].

3. Prior to their passing, [Deceased's Name] resided at [Deceased's Last Known Address], which was their last known address.

4. This information is provided to accurately record the essential details concerning the deceased's identity and the circumstances of their death.

5. I am the [Relationship to the Deceased] of the deceased and have personal knowledge of the facts stated herein.

6. This affidavit is executed for the purpose of requesting the official death certificate and for notifying government agencies and other relevant entities to update their records and terminate any ongoing benefits or services in the name of the deceased.

Legal Authority:

I affirm that I am legally authorized to act on behalf of the deceased's estate and have the legal standing to execute this affidavit.

Certification:

I certify that the information provided in this affidavit is true and correct to the best of my knowledge and belief. I understand that this affidavit is being made for the purposes of compliance with Utah laws and for the purpose of conducting lawful business concerning the deceased's estate.

DATED this [Day] of [Month], [Year].

Signature:

[YOUR NAME]

SUBSCRIBED AND SWORN TO before me this [Day] of [Month], [Year], by [YOUR NAME], who is personally known to me or who has produced identification in the form of driver's license.

[NOTARY PUBLIC NAME]

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