Affadavit - Bureau of TennCare Notification | Pdf Fpdf Doc Docx | Tennessee

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Affadavit - Bureau of TennCare Notification | Pdf Fpdf Doc Docx | Tennessee

Last updated: 9/30/2021

Affadavit - Bureau of TennCare Notification

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Description

IN THE CHANCERY COURT FOR WILLIAMSON COUNTY, TENNESSEE ESTATE OF:_____________________________________ ) ) AFFIDAVIT NO._________________ The Affiant, after being sworn, deposes and says: 1. 2. That (s)he is the Personal Representative for the above estate. That (s)he has notified the Bureau of TennCare of the decedent's death pursuant to T.C.A. §71-5-116. Further Affiant saith not. _______________________________ Affiant STATE OF TENNESSEE COUNTY OF _________________ Subscribed and sworn to before me, this the ________ day of __________________, 20___. _______________________________ Notary Public/Clerk & Master My Commission Expires: _________ American LegalNet, Inc. www.FormsWorkFlow.com

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