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Affidavit of Death

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Affiant
Decedent
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Deceased person (Decedent)

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What was the decedent's date of death?

What is the decedent's social security number?

What was the decedent's legal residence? (e.g. Street, City, State, Zip Code)

For how many years did the decedent reside at this address? e.g.(10,20 etc..)

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