Affidavit of Domicile
This document certifies the primary place of residence (domicile) of the deceased at the time of their death. It is made in accordance with the laws of the State in which the domicile is claimed. Please fill in the relevant details where indicated.
State of _________ (the "State")
County of _________
1. I, _____________ [Full name of the Affiant], residing at ______________________________________________ [Affiant's full Address], being duly sworn, declare under oath that:
2. Relationship to Decedent: I am the ________________________ [state your relationship to the deceased] of _____________________ [Full Name of the Decedent], hereinafter referred to as "the Decedent."
3. Date of Death: The Decedent passed away on ______________ [insert date of death].
4. Last Domicile: At the time of their death, the Decedent was domiciled in the State of ____________, specifically at the following address: ________________________________________________________ [insert Decedent's address].
5. Additional Property: To the best of my knowledge, at the time of their death, the Decedent □ did not own □ owned property in another state or states, which is/are listed as follows:
- _______________________________________________________
- _______________________________________________________
- _______________________________________________________
6. I make this affidavit to induce the _______________________ [entity requesting the affidavit, e.g., "XYZ Bank"] to recognize the Decedent's domicile for the purpose of concluding the affairs related to any accounts or properties held by the Decedent.
7. I understand that providing false information in this document can lead to penalties for perjury.
8. Affiant's Signature: _______________________ [signature of the Affiant]
9. Date: _______________________
Subscribed and sworn to before me this __________ day of ___________, 20__
Notary Public: _________________________________________
My commission expires: ___________________