Free affidavit of domicile 32Free affidavit of domicile 32
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Affidavit of Domicile

NavyFederalBrokerageServices,LLC(NFBS)
820 FollinLane
Vienna,VA 22180

Brokerage Services

NFBS 16-10

Telephone:(877)221-8108

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Member FINRA/SIPC

1

Account Information

Account Holder: First Name, Middle Initial

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Last Name

Account
Number

Decedent's Information

I, ____________________________________________, being duly sworn, state that I reside at: ______________________________________________,
(Executor/Survivor)

(Street)

City of ___________________________, County of _________________________, State of ________.
I am the Executor/Survivor of: _____________________________________________, who died on the _______day of ____________________, 20____.
(Name of Deceased)

At the time of death, the legal residence of said decedent was ________________________________________________,
(Street)

City of __________________________, County of _________________________, State of ________. Decedent resided in the State of ______