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Affidavit of Next of Kin

AFFIDAVIT OF NEXT OF KIN Use this form to manage the protected health information of someone who’s passed away. Enrollee ID of deceased member . The undersigned, being first duly sworn, deposes and states: 1. I am the next of kin of who died on or about the day of , 20 . 2. A copy of the decedent’s death certificate is attached. 3. 

DS-5511 Affidavit for the Surviving Spouse or Next of Kin

Providing the information in the affidavit is voluntary, but, failure to complete this form will require the person claiming to be next-of-kin to obtain and present alternative documents such as certified copies of Letters Testamentary, Letters of Administration, or trust 


NEXT OF KIN AFFIDAVIT FACT SHEET-UNDER $20,000.00-DECEDENT HAD NO WILL Page 1 of 4 [email protected](e-mail) To begin the application process please send copies of the following by e-mail, mail, fax or deliver to the office: Affidavit Fact Sheet Forms. Death certificate (original required) Estate Asset Form . At appointment, the 

Form F18: Affidavit of Next of Kin -

Form F18: Affidavit of Next of Kin The undersigned, being first duly sworn, deposes and says: Please keep a copy of this document for your records and email the completed Affidavit to Blue Cross and Blue Shield of Vermont, Attn: Customer Service, at [email protected] 

Next of Kin Affida - Alabama Department of Revenue

(assignment of title must be completed by the individual who completed this form). I certify, under penalty of perjury, that the above information is true and correct. _____ _____ _____ (Signature and Printed Name of Next of Kin required.) Next of Kin Affidavit SIGNATURE OF NEXT OF KIN PRINTED NAME OF NEXT OF KIN DATE MVT 5-6 2/20 

NEXT OF KIN AFFIDAVIT - New York State Comptroller

That this affidavit is made for the purpose of directing payment of the said debt to: the affiant, or _____, pursuant to SCPA Section 1310(3) (f), a creditor of the decedent or person who has paid or incurred the funeral expense of the decedent, not to exceed $5,000 (SCPA §1310(4)), upon the request of the surviving NEXT OF KIN AFFIDAVIT 

AFFIDAVIT - Justice/Home

department of justice and constitutional development gp-s 81/811521 j192 (81/811521) republic of south africa affidavit particulars of next-of-kin i, .. 

Next Of Kin Affidavit - US Legal Forms

Select the Get Form option to start modifying. Turn on the Wizard mode in the top toolbar to acquire more recommendations. Fill in every fillable field. Be sure the data you add to the Next Of Kin Affidavit is updated and correct. Include the date to the template with the Date feature. Click the Sign icon and make a signature. 


Form 78-014-10. AFFIDAVIT WHEN OWNER DIES WITHOUT A WILL. Title Bureau, P.O. Box 1383 Jackson, MS 39215 Phone 601-923-7200 FAX 601-923-7224. Attached to and made a part of the application for assignment of title to a vehicle when the owner dies without a will being (Signature of Next of Kin) _____ (Signature of Next of Kin)