California Affidavit of Death
This Affidavit of Death is prepared in accordance with California state law. It serves as a formal statement confirming the death of an individual. Please fill in the required information below.
Affiant Information:
- Name: _______________________________
- Address: _____________________________
- City, State, Zip: _____________________
- Phone Number: ________________________
Deceased Information:
- Name: _______________________________
- Date of Birth: ________________________
- Date of Death: ________________________
- Last Known Address: ___________________
Affidavit Statement:
I, the undersigned Affiant, declare under penalty of perjury that the following statements are true and correct:
- The above-named individual is deceased.
- The date of death is accurately stated above.
- I have personal knowledge of the facts stated in this affidavit.
Signature: _______________________________
Date: ___________________________________
Notary Public:
State of California
County of ________________
Subscribed and sworn to before me on this ____ day of ___________, 20__.
Notary Public Signature: _______________________________
My Commission Expires: _______________________________