I, [Your Name], being of lawful age and sound mind, hereby solemnly affirm and state under penalty of perjury that:

Statement of Facts

1. [Deceased's Name], whose date of birth was [Date of Birth], passed away on [Date of Death], in the city of [City Name], County of [County Name], State of Georgia.

2. I am aware of the circumstances surrounding the death of [Deceased's Name], and I can attest to the fact that the passing occurred due to [Cause of Death].

3. I am the [Relationship to Deceased] of the deceased, and I have personal knowledge of the events leading to and following the death.

4. A death certificate issued by the vital records office in [County Name], Georgia, confirms the death of [Deceased's Name], and I have attached a certified copy of the same to this affidavit.

5. The deceased was a resident of [Deceased's Address] in [City Name], Georgia, and had no outstanding debts or legal obligations at the time of their passing, to the best of my knowledge.

6. I understand that the purpose of this affidavit is to provide formal notification and verification of the death of [Deceased's Name] for legal and administrative purposes.

Sworn Oath

I solemnly declare that all statements made herein are true and accurate to the best of my knowledge 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 Georgia

My Commission Expires: [Expiry Date]

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