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Statutory declarations

Statutory Declaration of Death

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STATUTORY DECLARATION OF DEATH

I, ______, of ______, in the Province of Ontario, DO SOLEMNLY DECLARE THAT:

  1. My relationship to ______ (the “deceased”) is: ______.

  2. The deceased was born on ______ and, at the time of death, lived at ______.

  3. The deceased died on ______ at ______.

  4. I know of the death because ______.

  5. As of the date of this declaration, ______.

  6. I make this declaration at the request of ______, for the purpose of ______.

  7. AND I make this solemn declaration conscientiously believing it to be true, and knowing that it is of the same force and effect as if made under oath and by virtue of the Canada Evidence Act.

Signed and sworn (or affirmed/declared) before me by videoconference in Ottawa, Ontario, while the Affiant(s)/Declarant(s) were located in ______________________, on ______________________, pursuant to O. Reg. 431/20, and Electronic Commerce Act, 2000.

______________________________
A Commissioner of Oaths / Notary Public

______________________________
Signature of Declarant