Fillable Affidavit Of Domicile Template - Fillable printable pdf download

AFFIDAVIT OF DOMICILE

I, ____________________________________________________ being duly sworn, depose and state as follows:

Affiant (Your Name. If a Corporate Fiduciary, indicate Name and Title)

I reside at _____________________________________________ (street address), City of _____________________________,

County of __________________________________________, State of _____________________________________, and am

Please check one:

Executor

Personal Representative

Administrator

Joint Tenant Survivor

Heir at Law

of _______________________________________________ (deceased) who died on ___________________________.

Name of decedent

Date (mm/dd/yyyy)

At the time of death, the decedent’s residence and legal domicile was in the City of ______________________, County of

____________________________, and State of ____________________________, and had been the same for the preceding

_____ years. The decedent’s last Federal income tax return showed the decedent’s residence and domicile was in the City of

___________________________, County of __________________________, and State of __________________________.

The decedent last voted in the City of ___________________________, and State of ______________________.

The decedent was not at any time during the year preceding the date of death a resident of or domiciled in any state within the

United States of America other than the state of domicile shown above. The decedent executed no will or instrument within three

years prior to death in which the decedent stated he/she was a resident of any other State.

This Affidavit is made for the purpose of securing the transfer or delivery of property owned by the decedent at the time of his or

her death to a purchaser or persons legally entitled thereto under the laws of the decedent’s domicile and that any and all debts,

inheritance and estate taxes, administration expenses, legacies and claims against the estate have been paid or provided for.

PRINT then

ign and date in blue or black INK before a Notary Public

________________________________________

___________________________

Signature of Affiant

Date

Subscribed and sworn to before me, a NOTARY PUBLIC, this

______ day of _______________________, 20____

AFFIX SEAL OR STAMP

_______________________________________________

Signature of Notary Public

________________________________________________

Print Name of Notary Public

Commission Expires: _______________________________

03/2014

Affidavit Of Domicile Template - Fillable