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AFFIDAVIT OF DOMICILE
| STATE OF | ) |
)ss
| COUNTY OF | ) |
I, , residing at , , , being first duly sworn, state as follows:
I am the of the Estate of (the "Decedent") who died on .
At the time of death, the Decedent's domicile was , , and the Decedent had resided in the State of for at least year(s) prior to death, and was not a resident of any other state of the United States at the time of death.
The Decedent did not claim any state of domicile other than the State of on any instrument or Will executed within the two years prior to death.
At the time of death, the Decedent possessed . Certificate(s) representing Decedent's possession were physically located in , at the time of the Decedent's death.
____________________________________
Subscribed and sworn to before me this _____ day of ____________________, ______.
The foregoing instrument was acknowledged before me, by means of ☐ physical presence or ☐ online notarization, this _____ day of ____________________, ______ by _________________________, who is personally known to me or who has produced ________________________________ as identification.
COUNTY OF
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Yes, an Affidavit of Domicile Form needs the signature of a notary. Witnesses are not required.
