Free affidavit of death 27
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Prepared By:
Two Rivers Title Company, LLC
26 Ayers Lane
Suite 202
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:
1.

Affiant is the Surviving Spouse of , who died on , a resident of County of ____________, Florida.

2.

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 ________________.

3.
Affiant makes these statements to induce Two Rivers Title Company, LLC and
_______________ to issue its policies of title insurance to _______________.
FURTHER affiant sayeth naught.

Witnessed:
Print Name:

Print Name:

THE FOREGOING INSTRUMENT was acknowledged before me on by who is personally known to me
or who has