Louisiana Affidavit of Death

Introduction

I, [YOUR NAME], the undersigned Affiant, being duly sworn, depose and state as follows:

Statement of Facts

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

2. I am a resident of [CITY NAME], Louisiana, and have personal knowledge of the facts stated herein.

3. [DECEASED'S NAME] (the "Decedent") was a resident of [DECEASED'S ADDRESS], Louisiana, and passed away on [DATE OF DEATH].

4. The Decedent was the insured party under a life insurance policy issued by [INSURANCE COMPANY NAME], with policy number [POLICY NUMBER].

5. To the best of my knowledge, information, and belief, the Decedent is deceased, and no claim has been made against the above-referenced policy.

6. Attached hereto and made a part hereof as Exhibit A is a true and correct copy of the Death Certificate of the Decedent, issued by the [ISSUING AUTHORITY], which certifies the Decedent's death.

Sworn Oath

I do solemnly swear that the statements made herein are true and correct to the best of my knowledge, information, and belief.

Executed on this [DATE] day of [MONTH], [YEAR].

[YOUR NAME]

Affiant

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

Notary Public

My commission expires: [EXPIRATION DATE]

[NOTARY SEAL]

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