Affidavit Of Domicile Form
Download a blank fillable Affidavit Of Domicile Form in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Affidavit Of Domicile Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1AFFIDAVIT OF DOMICILE FORM
I. ACCOUNT INFORMATION
ACCOUNT TITLE:
ACCOUNT NUMBER:
—
II. DECEDENT’S INFORMATION
I,
being duly sworn, state that: I reside at
(Name of Executor/Administrator/ Survivor)
, City of
County of
State of
,
(Street Address)
and I am Executor/Administrator/Survivor of
, deceased,
(Name of Deceased)
who died on the
day of
, 20____. At the time of death the legal residence of said decedent was
, City of
County of
State of
,
(Street Address)
He/She resided in the State of
for
years prior to death, and was not a resident of any other state within
the United State of America, at the time of death. This affidavit is for the purpose of securing the transfer or delivery of
the securities registered in the name of or owned by the decedent at the time of his or her death.
III. SIGNATURE
AUTHORIZED SIGNATURE:
DATE:
SUBSCRIBED AND SWORN TO BEFORE ME THIS:_______________________ DAY OF ________________________, 20____________.
NOTARY PUBLIC:
INTRODUCING BROKER-DEALER NAME:
AFDD
Pershing LLC, a subsidiary of The Bank of New York Mellon Corporation.
PAGE 1 OF 1
Member FINRA, NYSE, SIPC. Trademark(s) belong to their respective owners.
FRM-AFFDOM-9-09
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal