California Affidavit of Death
This affidavit is signed to declare the death of an individual in compliance with California state laws.
Affiant Information:
- Name: ___________________________
- Address: _________________________
- Phone Number: ____________________
- Email: ___________________________
Decedent Information:
- Name: ___________________________
- Date of Birth: ____________________
- Date of Death: ____________________
- Last Known Address: _______________
Affiant, having personal knowledge of the facts stated herein, affirms the following:
- The decedent, ___________________________, passed away on ______________________.
- The location of death was ___________________________.
- The affiant is related to the decedent as ___________________________.
- This affidavit is executed in accordance with California Probate Code Section 13000.
This affidavit is executed on this ____ day of ______________, 20___.
Signature of Affiant: ___________________________
Printed Name of Affiant: _______________________
Notary Public:
I, ______________________________, Notary Public, do hereby certify that on the ____ day of ____________, 20___, I witnessed the signature of the above-named affiant.
Signature of Notary: _________________________
My commission expires: ____________________