Affidavit Of Domicile printable pdf download

AFFIDAVIT OF DOMICILE

STATE OF _______________________________)

) SS ______________________

COUNTY OF _____________________________)

___________________________________________ , being duly sworn, deposes and

says that (he/she/they) resides at ___________________________________________

State of ____________________________ , and is Executor

)

Administrator of the Estate of)

Survivor with joint tenancy ) _____

____________________________ , Deceased who died at ___________________ on the

____________________ day of ____________ , ___ , that at the time of his/her death

the domicile (legal residence) of said decedent was at ___________________________,

County of ______________, State of __________________ , that decedent resided at

such address for __________ years, such residence having commenced on ___________,

____ , that decedent last voted in the year _____ at _________________ County of

______________ , State of ___________________ , that decedent's principal place of

business at the time of his/her death was at ______________ , County of ___________ ,

State of __________________ , that decedent's most recent Federal Income Tax Return

showed his legal residence as _______________________ , County of ____________ ,

State of _____________________ ; that within three years prior to death decedent was

not a resident of another state ("if decedent resided in another state within three years

prior to death, set forth the name of the state and facts as to change of residence and

establishment of final domicile) ;

that any and all debts, taxes legacies and claims against the estate have been paid or

provided for; that this affidavit is made for the purpose of securing the transfer or

delivery of property owned by the decedent at the time of his/her death to a purchaser or

the person or persons legally entitled thereto under the laws of decedent's domicile and

that any apparent inequality in distribution has been satisfied or provided for out of other

assets in the state.

Sworn to (or affirmed) before me this

____________________________________

_____________ day of _____ , ____

Executor

Executrix

______________________________

Administrator

Administratrix

______________________________

Survivor

(Give official capacity of official administering

oath)

My Commission expires __________________

NOTARY SEAL

Affidavit Of Domicile