New Hampshire Affidavit of Death
STATE OF NEW HAMPSHIRE
COUNTY OF [County Name]
Introduction:
I, [YOUR NAME], of [YOUR ADDRESS], sworn under oath, declare:
Statement of Facts:
The deceased, [Deceased's Name], was born on [Date of Birth] and sadly passed away on [Date of Death].
The death occurred in [City/Town, State Name].
This affidavit is prepared in connection with the death of [Deceased's Name] to formally document these details for legal and administrative purposes.
I am the [Relationship to Deceased] of the aforementioned deceased and have personal knowledge of the facts herein.
This Affidavit of Death is executed for the purpose of informing [Pension Plan Name/Government Agency/Private Company] regarding the death of [Deceased's Name] to adjust benefits, terminate services, or any other necessary action as per the policies of [Pension Plan Name/Government Agency/Private Company].
Attached Documentation:
Statement of Truth:
I affirm that the information provided in this affidavit is true and correct to the best of my knowledge.
Further Action:
I request that [Pension Plan Name/Government Agency/Private Company] take the necessary actions as per their policies and procedures in light of the deceased’s passing.
DATED this [Day] of [Month], [Year].
Signature:
[YOUR NAME]
Subscribed and sworn to before me this [Day] of [Month], [Year].
[NOTARY PUBLIC NAME]
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