Grco Form A Affidavit Of Residency (Domicile) For Decedent - County Of Greenville
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1STATE OF SOUTH CAROLINA
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IN THE PROBATE COURT
COUNTY OF GREENVILLE
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AFFIDAVIT OF RESIDENCY (DOMICILE)
FOR DECEDENT
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IN THE MATTER OF:
)
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CASE NUMBER: ______________________
(Decedent)
)
The above-named Decedent was a resident of Greenville County residing at ___________________________________
_______________________________, ___________________________, S. C. _________ at the time of his/her death.
I understand residency (domicile) for the purpose of estate administration is the place of the Decedent’s home, a place in
which he/she was closely connected and would return after being absent, if physically able.
The address on the Death Certificate is the Decedent’s:
Nursing Home address
Address of a Relative or Friend that Decedent was visiting with or living with due to an advanced illness
Assignment via Armed Forces
Address Decedent was physically located when he/she was hospitalized/died
Prison address
I do not recognize the address on the Death Certificate
Other: ____________________________________________________________________________________
The Decedent was closely connected to the address in the first paragraph as follows:
(mark only those choices that apply to this Decedent and mark only those choices known to you of your own personal knowledge)
Address is Decedent’s house/condominium which he/she owns
Address is Decedent’s apartment which he/she rented
Address is that of Decedent’s mobile home which he/she owned
Address is on Decedent’s Voter’s Registration Card
Address is on Decedent’s S. C. Driver’s License, Automobile Registration, U.S. Passport, S. C. ID Card
Address is the same address listed with Social Security Administration and Medicare
Address is on Decedent’s most recent state and/or federal tax return
Address is where Decedent’s surviving spouse, companion, or adult child continues to live
Address is on file with Decedent’s medical providers, insurers, creditors, bank and/or investment accounts
____________________ County Probate Court advised that the estate should be probated in Greenville County
Other: ____________________________________________________________________________________
Based on the foregoing, I affirm that Greenville County, South Carolina, was the residence/domicile of the Decedent.
Executed this _____ day of _________________________, 20_____.
SWORN to before me this
day of
Signature:
, 20
Print Name:
Address:
Notary Public for South Carolina
Telephone (Work):
My Commission Expires:
(Home):
(Cell):
E-mail:
Relationship to Decedent/Estate:
GrCo FORM A (7/2014)
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