Free Affidavit of Domicile - PDF | Word Template

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The Affidavit of Domicile must be completed by the executor or administrator of an estate and notarized by a notary public before stocks, bonds, or other securities that are part of the estate can be transferred or sold. It establishes the state in which the decedent held the securities, which is the state that can levy taxes. You may need to complete a separate Affidavit of Domicile for each bank or brokerage. This form verifies your identity and your statements in regards to the deceased and the securities. It does not confirm your authority to act on behalf of the estate and it does not confirm ownership of the securities in question.

How to Write

  • Enter your full name.
  • Enter your complete address including city and state.
  • Enter the capacity in which you are representing the estate (typically executor or administrator).
  • Enter the full name of the deceased.
  • Enter the date of death.
  • Enter the city, county, and state where the deceased resided at the time of his or her death.
  • Enter again the state where the deceased resided at the time of his or her death.
  • Enter again the state where the deceased resided at the time of his or her death, if the deceased had indeed resided in that state for two years prior to his or her death. If the deceased did live in a different state prior to his or her death, consult with an attorney about preparing an alternative affidavit.
  • Enter the name of the company, bank, brokerage house, or other entity that the securities represent.
  • Enter the city, county, and state where the actual physical copies of the securities were located at the time of the deceased’s death.
  • Take this form to a notary public in your state. The notary public will verify your identity (typically through a government-issued identification document), witness your signature, enter the date the affidavit was signed, and apply his or her seal.

This notarized Affidavit of Domicile is necessary to transfer securities to the heirs of the estate or to liquidate them in order to distribute the estate. It must be provided to the company, bank, brokerage house, or other entity that administers the securities. You will likely need to complete a separate Affidavit of Domicile for each instrument in the estate. You may need to supply other documents such as a death certificate. This affidavit only certifies your identity and your statements. It does not in itself authorize you to act on behalf of the estate and it does not make any claim as to the ownership of the securities.

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Sample Affidavit of Domicile

Affidavit of Domicile