Affidavit of Domicile
I, the undersigned __________________(full legal name) do hereby make oath and say that:1. I reside at:
and act as ______________ (e.g. executor / administrator / heir /survivor) of the Estate of
___________________(full legal name), Deceased.
2. The decedent died on the _____ day of _______________ 20__. I annex hereto, marked "A" a
true copy of the Death Certificate.
3. At the time of death the decedent's only legal address was at:
where he/she lived for a period of _______ years immediately prior to death.
4. The decedent executed a Last Will and Testament on the ______ day of _____________ in the
year _____, revoking all previously made wills and codicils and stating his/her address as:
5. The facts contained in this affidavit are true and correct.
SIGNATURE and FULL LEGAL NAME OF DEPONENT
Sworn to and described before me on this _____ day of _______________