Free affidavit of domicile 44
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AFFIDAVIT OF DOMICILE

STOCKCROSS®

Email: [email protected] | Phone: 800.225.6196 | Fax: 402.342.2486

F INAN CIAL S ERVIC ES

State of ______________________________
County of _____________________________
(Name):

, being duly sworn, deposes and says that he/she/they reside(s) at

(address)___________________________________________________,State of________ and is: (Please check and fill in
one)

Executor/rix of the Estate of _________________________________________________________________

Administrator/rix of the Estate of ______________________________________________________________
Survivor of the Joint Tenancy with_____________________________________________________________
Beneficiary of the account of _________________________________________________________________,
deceased who died at (location)_____________________________________________ on (date) ____/____/20____; at the time of his/her
death the domicile (legal residence) of said decedent was at

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