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| Affidavit of Domicile |
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1, __________________ (State Your Role), residing at ________________________, being first duly sworn, state as follows: I am the _____________________ (Your Role) of the Estate of ___________________ (“Decedent”) who died on ____________ (“Date of Death”). At the time of death, the Decedent's domicile was _____________________________, and the Decedent had resided in the State of ___________________ 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. Certificate(s) representing ___________________ were physically located in ________, at the time of the Decedent's death. __________________ Maker of Affidavit Subscribed and sworn to before me this __ day of ________, 20__. _____________ Notary Public My Commission Expires on: ______________ |
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