Affidavit Of Domicile Form printable pdf download

AFFIDAVIT OF DOMICILE

IN THE MATTER OF THE ESTATE OF

, Deceased, also known as

__________________________________________ (as named on death certificate or letters testamentary)

STATE OF_______________________________________

(State where Notarized)

COUNTY OF_____________________________________

(County where Notarized)

I, ______________________________________being duly sworn, deposes and says as follows:

(Print Your Name)

THAT my address

is_____________________________________________________________________________

THAT I am Executor [ ]

Surviving joint tenant [ ]

Successor Trustee [ ]

Administrator [ ]

Spouse [ ]

Personal Representative [ ]

Successor [ ]

of the Estate of_____________________________________________________, Deceased;

(Name of Deceased)

THAT said decedent died in_______________________________on the___________day

(state or country)

of (month) ______________________, (year) __________;

THAT at the date of death, the domicile (legal residence) of said decedent was at:

City/County of ______________________ State of ________________ and was not a resident of any other state;

THAT any and all debts, taxes and claims against the estate have been paid or provided for so that the securities

registered in the name of Account # _______________ Registration _____________________________________

______________________________________________________ are entirely free for transfer and distribution;

THAT this affidavit is made for the purpose of securing the transfer or delivery of property owned by decedent at

the time of his/her death to a person or persons legally entitled thereto under the laws of the decedent's domicile

and that any apparent inequality in distribution has been satisfied or provided for out of other assets in the estate.

Sworn to before me this

_______________________________________

_____day of___________________, 20_____

Type or Print Your Name

_____________________________________

________________________________________

Notary Public

Sign and circle the appropriate title below:

Executor/Executrix

My Commission expires__________________

Administrator

Personal Representative

Survivor

NOTARY CERTIFICATION

Successor

Doc. Date:__________Undated________________________ # of Pages: _1_

Successor Trustee

Notary Name:_______________________________________ _____ Circuit

Doc. Description: Affidavit of Domicile

_______________________________________________________________

Notary Signature

Date

Affidavit Of Domicile Form

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