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

Statement of Facts

1. I am of legal age and competent to make this affidavit.

2. [DECEASED PERSON'S NAME] (hereinafter referred to as the "Decedent") departed from this life on [DATE OF DEATH], in the County of [COUNTY NAME], State of West Virginia.

3. The Decedent's last known residence was at [DECEASED'S ADDRESS], County of [COUNTY NAME], State of West Virginia, at the time of their death.

4. The Decedent's Social Security Number was [SOCIAL SECURITY NUMBER] and their date of birth was [DATE OF BIRTH].

5. The Decedent is survived by [NAME OF SURVIVING RELATIVES].

6. An official copy of the Decedent's death certificate, denoted as Exhibit A, is appended hereto, and I affirm its accuracy and authenticity.

7. It is hereby declared that the Decedent's last will and testament, if any, has been duly filed with the appropriate authorities and is being administered according to the laws of the State of West Virginia.

8. The Decedent's estate, to the best of my knowledge, is not subject to any pending litigation or claims.

Sworn Oath

I solemnly affirm, under penalty of perjury, that the foregoing statements are true and correct 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 West Virginia

My Commission Expires: [Expiry Date]

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