Wyoming Affidavit of Death
Introduction
I, [YOUR NAME], 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], Wyoming.
I am the [RELATIONSHIP TO DECEASED] of the deceased, [DECEASED'S NAME], who passed away on [DATE OF DEATH] in [CITY NAME], Wyoming.
The deceased was a resident of [CITY NAME], Wyoming at the time of his/her death.
The deceased was the holder of an insurance policy with [INSURANCE COMPANY NAME], policy number: [POLICY NUMBER], with coverage for [TYPE OF COVERAGE].
Sworn Oath
I solemnly swear that the foregoing statements are true and correct to the best of my knowledge and belief. I understand that making false statements in this affidavit is a criminal offense punishable by law.
Executed this [DATE OF EXECUTION] in [CITY NAME], Wyoming.
[YOUR NAME]
Affiant
Witness Statement
I hereby certify that on [DATE OF EXECUTION], [YOUR NAME] appeared before me and signed or acknowledged signing this affidavit. I further certify that I am not a party to this action and am not related by blood or marriage to any party to this action.
[WITNESS NAME]
Witness
Notary Acknowledgment
State of Wyoming
County of [COUNTY NAME]
On this [DATE OF NOTARIZATION], before me, a Notary Public in and for said County and State, personally appeared [YOUR NAME], known to me to be the person whose name is subscribed to the foregoing instrument, and acknowledged that he/she executed the same for the purposes therein contained.
Notary Public
My Commission Expires: [NOTARY EXPIRY DATE]
[NOTARY SEAL]
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