State of Pennsylvania

I, [Your Name], residing at [Your Address], being duly sworn, depose and state as follows:

Statement of Facts

1. I affirm that 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 departed on [Date of Death], within the confines of [County Name], Pennsylvania.

3. To the utmost extent of my knowledge, supported by reliable information and belief, I attest that at the time of [Deceased's Name]'s decease, their primary and enduring dwelling was situated at [Deceased's Address] in the State of Pennsylvania.

4. Documentation reveals that [Deceased's Name] possessed a valid Pennsylvania driver's license, issued with the aforementioned address as their residential location.

5. Comprehensive examination of real property records unveils that [Deceased's Name] was the lawful owner of real estate situated at [Deceased's Address], serving as their principal abode.

6. Further testament to [Deceased's Name]'s ties to the local community is evidenced by their active participation in civic engagements and cultural events within Pennsylvania.

Sworn Oath

I, as the affiant, hereby solemnly confirm that the assertions made herein are true and correct to the best of my knowledge, belief, and understanding.

Signature

[Your Name]
Affiant

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

[Notary Public's Name]

Notary Public

My Commission Expires: [Expiry Date]

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