I, [Your Name], being duly sworn, hereby depose and state the following:

STATEMENT OF FACTS

1. I am of legal age and mental capacity to execute this affidavit.

2. I am the [Relationship to Deceased] of the deceased individual, [Deceased's Name], who died on [Date of Death], within the jurisdiction of [County Name], State of North Dakota.

3. I can affirm, based on my knowledge and belief, that at the time of [Deceased's Name]'s demise, their primary and permanent abode was situated at [Deceased's Address], State of North Dakota.

4. Documentation indicates that [Deceased's Name] possessed a valid driver's license issued by the state of North Dakota, which listed the aforementioned address as their residence.

5. According to electoral records, [Deceased's Name] was registered to vote in elections conducted within the State of North Dakota, utilizing the provided address for voter registration purposes.

6. Real estate records confirm that [Deceased's Name] owned property located at [Deceased's Address], which served as their principal dwelling and was subject to property tax assessments within [County Name].

7. [Deceased's Name] was an active member in the community, as evidenced by their participation in local events and membership in various civic organizations within North Dakota.

OATH AND DECLARATION

I attest that all foregoing statements are true and accurate to the best of my knowledge, understanding, and belief.

SIGNATURE

[Your Name]
Affiant

Subscribed and sworn to before me this [Day] day of [Month], [Year].

[Notary Public's Name]

Notary Public for the State of North Dakota

My Commission Expires: [Expiry Date]

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