Notice to Creditor of Death

Date: ______________

____________________________
____________________________
____________________________
____________________________
[insert name and address of creditor]

Name of deceased: ____________________________
Deceased's Address:	_____________________
_____________________
Account number: ____________________________
Date of death: ____________________________

To whom it my concern:
I am the representative of the decedent. Please cancel this account at once.
Please also acknowledge that you received this notice by signing the duplicate of this letter and returning it to me in the enclosed stamped, self-addressed envelope.
If there is any outstanding balance on this account, please promptly notify me at the address set out below. 
Thank you for your assistance.

Signature: ___________________________________________
Printed or typed name: ____________________________
Relationship to deceased: ____________________________
Address:	____________________________
____________________________
Home phone: ________________	Work phone: ____________________

Receipt acknowledged by:

Signature: ___________________________________________
Printed or typed name: ____________________________
Title: ____________________________
Date of receipt of notice: _____________