California Affidavit of Death
This affidavit is prepared in accordance with California law and should be used for the purpose of establishing the death of a person for legal or administrative needs. Please fill in the blanks as applicable.
State of California
County of __________
Before me, the undersigned authority, personally appeared:
Affiant's Name: __________
Affiant's Address: __________
City, State, Zip: __________
Who, being duly sworn, deposes and says:
- Decedent’s Name: __________
- Date of Death: __________
- SSN of Decedent: __________
- Place of Death: __________
The undersigned affiant certifies that:
- The information provided herein is true and correct to the best of my knowledge.
- I am related to the decedent as follows: __________.
- No other person has been appointed to administer the estate of the decedent.
- I have no information regarding any objections to this declaration.
This affidavit is intended to be used for the following purposes:
- To be presented to institutions or entities requiring proof of death.
- To assist in the transfer of assets owned by the decedent.
Executed this _____ day of __________, 20___.
______________________________
Affiant’s Signature
Subscribed and sworn to before me, this _____ day of __________, 20___.
______________________________
Notary Public, State of California
My Commission Expires: __________