Introduction

I, [YOUR NAME], being duly sworn on oath, depose and state as follows:

• I am over the age of eighteen (18) and am of sound mind.

• I reside at [YOUR ADDRESS], in the County of [COUNTY NAME], State of Michigan.

• I am making this Affidavit in connection with the death of [DECEASED'S NAME], who passed away on [DATE OF DEATH].

Statement of Facts

1. [DECEASED'S NAME], the deceased, was born on [DATE OF BIRTH] and was a resident of [DECEASED'S ADDRESS].

2. The deceased was insured under a life insurance policy issued by [INSURANCE COMPANY NAME], policy number [POLICY NUMBER].

3. I am familiar with the terms of the life insurance policy and know that it provides for the payment of benefits upon the death of the insured.

4. To the best of my knowledge, the deceased did not revoke or otherwise modify the life insurance policy before their death.

5. I am aware that I am named as the beneficiary of the life insurance policy and am entitled to receive the benefits under the policy.

6. I have attached a copy of the death certificate of the deceased, issued by the [ISSUING AUTHORITY].

Sworn Oath

I do solemnly swear that the foregoing statements are true and correct to the best of my knowledge, information, and belief.

[YOUR NAME]

Affiant

Sworn to and subscribed before me on this [DATE] day of [MONTH], [YEAR].

Notary Public

My Commission Expires: [EXPIRATION DATE]

[NOTARY SEAL]

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