Affidavit Of Domicile Form printable pdf download

Affidavit of Domicile

Merrill Lynch Account Number ____ ____ ____ — ____ ____ ____ ____ ____

All the fields provided below are required.

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

Affiant (Your Name. If a Corporate Fiduciary, Show Name & Title of Individual Signing, & Name and Address of Corporation)

I reside at _________________________________________ (street address), City of __________________________________________________,

County of ___________________________________________________, State of ________________________________________________, I am

Please check one:

executor

personal representative

administrator

survivor of joint tenancy

heir at law

of _____________________________________________________________________, (deceased) who died on ____ day of _______, 20________.

(Day)

(Month)

(Year)

At the time of death, the decedent’s residence and domicile (legal residence) 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.

X ____________________________________________________________________

_____ /_____ /___________

Signature of Affiant

Date

THIS JURAT MAY NOT BE USED BY CALIFORNIA NOTARIES. CALIFORNIA NOTARIES ARE TO USE THE ATTACHED

JURAT ON PAGE 2 OR THE JURAT AVAILABLE ON THE CALIFORNIA SECRETARY OF STATE WEBSITE.

Notarization is Required

State of___________________________________________ County of ___________________________________________

Subscribed and sworn to (or affirmed) before me this ____ day of _______, 20________,

(Day)

(Month)

(Year)

by, _____________________________________________________, proved to me on the basis of satisfactory evidence to be the person(s)

(Name of Affiant must match Affiant name listed above)

who appeared before me.

X ____________________________________________________________________

_________________________

(Affix Seal or Stamp)

Signature of Notary Public

X ____________________________________________________________________

Print Name of Notary Public

Please check one of the following (required):

Personally Known OR

Produced Identification

Type of Identification Produced ______________________________________________

Code 0088 Rev. 08/15

Page 1 of 2

Affidavit Of Domicile Form

Related Articles

Related forms

Related Categories