New Mexico Affidavit of Death
Introduction
I, [YOUR NAME], being of lawful age and sound mind, hereby depose and state as follows under penalty of perjury:
Statement of Facts
I am the [RELATIONSHIP TO DECEASED], of the deceased, [DECEASED'S NAME], who passed away on [DATE OF DEATH], in [COUNTY NAME], New Mexico.
The deceased was a resident of [COUNTY NAME], New Mexico, at the time of their death.
The deceased was insured under policy number [INSURANCE POLICY NUMBER] with [INSURANCE COMPANY NAME], for which a claim is being made.
The cause of death was [CAUSE OF DEATH], as certified by [CERTIFYING AUTHORITY].
Sworn Oath
I solemnly swear that the foregoing statements are true and correct to the best of my knowledge, information, and belief. I understand that any false statements made herein are subject to penalties for perjury.
Executed on this [DATE] day of [MONTH], [YEAR].
[YOUR NAME]
Affiant
Notary Acknowledgment
State of New Mexico
County of [COUNTY NAME]
Subscribed and sworn to before me this [DATE] day of [MONTH], [YEAR], by [YOUR NAME], who is personally known to me or who has produced [type of identification] as identification.
Notary Public
My Commission Expires: [EXPIRATION DATE]
[NOTARY SEAL]
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