Free affidavit of domicile 47
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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
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 t