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Affidavit of Domicile and Debts. THE UNDERSIGNED, being duly sworn, deposes and states, the following: 1. The name of the decedent is . 2. Decedent died on The personal representative, executor or administrator of a deceased individual's estate should create an Affidavit of Domicile when trying to transfer or cash. The following affidavit will be used by the Washington State Department of Revenue to help residency of a decedent when the state of domicile is in dispute. To request this document in an alternate format, please call 1-800-647-7706. 21 Sep 2015 This affidavit is made for the purpose of securing the transfer or delivery of legally entitled thereto under the laws of the decedent's domicile. deceased,. (Name of Deceased) who died on the day of. , 20_ . At the time of death the legal residence of said decedent was. , City of. County of. State of. deceased, who died on the ______ day of______________ 20_______; at the time of his/her death the domicile (legal residence) of said decedent was 20 Apr 2016 Follow these instructions to complete the Affidavit of Domicile form: 1. Indicate your relationship to deceased shareholder (circle applicable At the time of death, the decedent's domicile (legal residence) was: This affidavit is made for the purpose of securing the transfer or delivery of property A notary public or other officer completing this certificate verifies only the identity of the Sign the form and ensure that it is notarized. • See Section 5 for instructions on returning your completed form. TELL US ABOUT THE DECEDENT. Decedent's Sign the form and ensure that it is notarized. Affidavit of Domicile the person or persons legally entitled thereto under the laws of the decedent's domicile and.
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