Louisiana Affidavit of Death
Introduction
I, [YOUR NAME], the undersigned Affiant, being duly sworn, depose and state as follows:
Statement of Facts
I am over the age of eighteen (18) years and am competent to make this Affidavit.
I am a resident of [CITY NAME], Louisiana, and have personal knowledge of the facts stated herein.
[DECEASED'S NAME] (the "Decedent") was a resident of [DECEASED'S ADDRESS], Louisiana, and passed away on [DATE OF DEATH].
The Decedent was the insured party under a life insurance policy issued by [INSURANCE COMPANY NAME], with policy number [POLICY NUMBER].
To the best of my knowledge, information, and belief, the Decedent is deceased, and no claim has been made against the above-referenced policy.
Attached hereto and made a part hereof as Exhibit A is a true and correct copy of the Death Certificate of the Decedent, issued by the [ISSUING AUTHORITY], which certifies the Decedent's death.
Sworn Oath
I do solemnly swear that the statements made herein are true and correct to the best of my knowledge, information, and belief.
Executed on this [DATE] day of [MONTH], [YEAR].
[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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