Two Rivers Title Company, LLC
26 Ayers Lane
Little Silver, NJ 07739
Incidental to the issuance of a title insurance policy
File Number: TRT ______
DEATH CERTIFICATE AFFIDAVIT
STATE OF FLORIDA
COUNTY OF _____________
The undersigned being duly sworn and deposed states:
Affiant is the Surviving Spouse of , who died on , a resident of County of ____________, Florida.
Affiant has reviewed that certain Death Certificate dated _____________, which provides:
A) The last residence of the decedent was _______________________.
B) The surviving spouse of the decedent is Affiant.
C) The Social Security Number of the decedent was ________________.
Affiant makes these statements to induce Two Rivers Title Company, LLC and
_______________ to issue its policies of title insurance to _______________.
FURTHER affiant sayeth naught.
THE FOREGOING INSTRUMENT was acknowledged before me on by who is personally known to me
or who has