Kansas Affidavit of Death
I, [YOUR NAME], residing at [YOUR ADDRESS], do hereby solemnly affirm and declare under penalty of perjury that I have personal knowledge of the death of [DECEDENT'S NAME] (hereinafter referred to as the "Decedent"), who passed away on [DECEDENT'S DEATH DATE].
Statements
I certify the following facts regarding the death of the Decedent:
The Decedent was a resident of [CITY NAME], KS.
The Decedent passed away on [DECEDENT'S DEATH DATE].
I have personal knowledge of the Decedent's death as a family member.
I understand that it is necessary to inform relevant government agencies about the Decedent's passing to facilitate the closure of accounts and termination of contracts.
I hereby request that the appropriate actions be taken to close any accounts or terminate contracts held by the Decedent with your agency.
I am aware that providing false information in this Affidavit is punishable by law.
I affirm that the statements made herein are true and correct to the best of my knowledge and belief.
Signatures
Dated this [DATE].
[YOUR NAME]
[WITNESS' NAME]
[NOTARY PUBLIC'S NAME]
Notary Public
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