AFFIDAVIT OF DOMICILE
STATE OF ____________________
COUNTY OF ____________________
I, ____________________, having been duly sworn, do depose and attest that I reside at ____________________, in the county of ____________________ in the state of ____________________ and that I have resided there for ____________________ days.
I am the _____ Executor _____ Representative _____ Heir for the deceased, named ____________________, who died on ____________________.
At the time of death, the deceased was residing at the following address: ____________________, in the county of ____________________ in the state of ____________________.
The deceased resided at the aforementioned address for ____________________ years prior to death, and was not a resident of any other state during that time.
This affidavit is made for the purpose of securing the transfer or delivery of property or securities registered to or owned by the deceased at the time of death to a purchaser or persons legally entitled thereto under the laws of the deceased's domicile.
Subscribed and sworn to before me this ____________________ day of ____________________ 20 ____________________
My commission expires ____________________ 20 ____________________