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Affidavit of Domicile Template
Confirm a decedent’s legal residence with a clear Affidavit of Domicile for banks and transfer agents using this template.
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Affidavit of Domicile Template
This Affidavit of Domicile (the “Affidavit”) is made on [Date] by:
Affiant: [Full Name], address: [Address], phone/email: [Contact].
Relationship/Authority: ☐ Executor/Personal Representative ☐ Surviving Spouse ☐ Heir ☐ Other: [Explain]
Decedent: [Full Legal Name]
Date of Death: [Date]
Place of Death (City/State): [City/State]
1. Purpose
1.1 I am making this Affidavit to confirm the Decedent’s legal domicile for estate administration and/or transfer of assets.
2. Domicile Information
2.1 Domicile Address: [Street, City, State, ZIP/Country].
2.2 Time at This Address: The Decedent lived at this address from approximately [Month/Year] until [Date of death].
2.3 Permanent Home Statement: To the best of my knowledge, the Decedent considered this address to be their permanent home and intended to remain domiciled there.
3. Other Residences (If Any)
3.1 The Decedent had other residences: ☐ No ☐ Yes (describe):
Address: [] | Use: ☐ vacation ☐ temporary work ☐ family ☐ other: []
Time period: [__]
3.2 These other residences did not change the Decedent’s domicile as stated above, to the best of my knowledge.
4. Estate and Identification (Optional)
4.1 Estate/Case (If Any): [Court/County], Case No.: [__].
4.2 Letters/Appointment (If Any): Issued on [Date] (attach copy if available).
4.3 Decedent Tax ID/SSN (Last 4 digits only): [____].
4.4 Asset Holder/Institution (If Applicable): [Bank/Broker/Transfer Agent name].
5. Supporting Documents (Attach as Available)
5.1 ☐ Certified death certificate
5.2 ☐ Letters testamentary/administration (if applicable)
5.3 ☐ Proof of address (utility bill, ID, tax record)
5.4 ☐ Will (if applicable)
5.5 ☐ Other: [List]
6. Statement Under Oath
6.1 I declare under penalty of perjury that the statements in this Affidavit are true and correct to the best of my knowledge.
Signatures
Affiant: [Full Name]
Date: [Date]
Signature: ___________________________
Witnesses (If Required)
Witness Name: [Name]
Date: [Date]
Signature: ___________________________
Notary / Notarization (If Required)
State of [State]
County of [County]
On [Date], before me, [Notary Name], personally appeared [Affiant Full Name], known to me (or satisfactorily proven) to be the person whose name is subscribed to this Affidavit, and acknowledged that they executed it for the purposes stated.
Notary Public Signature: _______________________
My Commission Expires: _______________________
Notary Seal (if applicable): ___________________
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Affidavit of Domicile Template
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For quick answers, scroll below to see the FAQ.
Click below for detailed info on the template.
For quick answers, scroll below to see the FAQ.
AFFIDAVIT OF DOMICILE TEMPLATE FAQ
What is an affidavit of domicile?
An Affidavit of Domicile is a sworn statement confirming a person’s legal residence (domicile), most commonly used after someone dies. Banks, brokers, and transfer agents may request it to process asset transfers, determine tax reporting, or complete estate-related paperwork.
Who completes the affidavit?
Typically the executor/personal representative, surviving spouse, or another person familiar with the decedent’s residence completes it. The signer should have personal knowledge and be able to provide supporting documents if requested.
What information is included?
Common items include: decedent’s name, date of death, domicile address, how long the decedent lived there, confirmation that the decedent intended it as their permanent home, and the affiant’s relationship and authority. This template includes optional estate/appointment fields.
Do you need a notary?
Often yes. Financial institutions frequently require notarization. This template includes a notarization section and an optional witness section if needed.
Is domicile the same as mailing address?
Not always. Domicile usually refers to the person’s permanent legal residence. Someone may have multiple residences, but only one domicile. This template includes a section to explain other residences if relevant.
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