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Affidavit of Domicile Template – Free Download 2026
Download a professional affidavit of domicile template. Customizable for all 50 states, available in PDF and DOCX formats. Attorney-verified and ready to use.
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When Do You Need a Affidavit of Domicile?
A shareholder or account holder has died and the transfer agent (such as Computershare) requires an affidavit of domicile to determine the decedent's state of legal residence for estate tax purposes before releasing or transferring the securities.
The executor or personal representative of the estate is closing brokerage accounts, mutual fund accounts, or other financial accounts held by the decedent and the financial institutions require documentation of the decedent's domicile to comply with state tax withholding requirements.
The estate must file state estate tax or inheritance tax returns and the filing state needs to be established through a sworn statement. The difference between domicile and residence is critical because a person can have multiple residences but only one legal domicile.
The DTCC (Depository Trust and Clearing Corporation) or a broker-dealer requires an affidavit of domicile as part of the standard documentation package for transferring securities from a deceased account holder to the estate, beneficiaries, or a trust.
A state tax authority is claiming the decedent was domiciled in their state for estate tax or inheritance tax purposes and the estate needs to submit a domicile affidavit (such as New York Form TT-141A) to contest the claim and establish domicile in a different state. An affidavit of death is typically filed alongside the domicile affidavit.
The executor is transferring the decedent's stock holdings to beneficiaries and the transfer agent requires proof that the estate has determined the correct domicile for purposes of state tax clearance before processing the share transfer.
What Should a Affidavit of Domicile Include?
Executor or Personal Representative Information
Identify the executor or personal representative by full legal name, address, and capacity. Reference the letters testamentary or letters of administration that grant the authority to act on behalf of the estate. Include the court that issued the letters and the case number.
Decedent Information
State the decedent's full legal name, date of birth, date of death, Social Security number, and the address that was the decedent's legal domicile at the time of death. The domicile address is the place the decedent considered their permanent home and intended to return to when absent.
Domicile Determination Factors
Describe the factors supporting the domicile determination, including where the decedent voted, filed state income tax returns, maintained a driver's license, registered vehicles, held professional licenses, received mail, and belonged to religious or civic organizations. The more factors pointing to a single state, the stronger the domicile determination.
Property and Account Identification
List the specific securities, accounts, or assets for which the affidavit is being submitted. Include account numbers (or last four digits), the name of the financial institution or transfer agent, and the approximate value. Transfer agents like Computershare often provide their own affidavit of domicile forms that must be used.
Tax Representations
Include a statement that the executor has determined the decedent's domicile for estate tax purposes and that no other state has a superior claim to tax the estate based on domicile. Some states require a tax waiver or clearance letter to accompany the affidavit before securities can be transferred.
Oath and Notarization
The executor must sign the affidavit under oath before a notary public. The oath states that the information is true and correct to the best of the executor's knowledge and that the executor understands making false statements constitutes perjury. The notary verifies identity, administers the oath, and applies the notary seal.
Signature Requirements
Electronic Signature with Notarization
The affiant must sign this affidavit under oath before a notary public. Notarization is mandatory because financial institutions, transfer agents, and brokerage firms require notarized affidavits of domicile to determine state tax jurisdiction and process asset transfers from deceased account holders.
How to Fill Out a Affidavit of Domicile
Enter Executor Information
Fill in your full legal name, address, and your capacity as executor or personal representative. Reference the letters testamentary by court name, case number, and date issued. Attach a copy of the letters if required by the financial institution.
Enter Decedent Details
Fill in the decedent's full legal name, date of birth, date of death, and Social Security number. Enter the address that was the decedent's legal domicile at the time of death. This is the address the decedent considered their permanent home.
Document Domicile Factors
List the objective factors that establish the decedent's domicile: voter registration state, state income tax filing state, driver's license state, vehicle registration state, and where the decedent spent the majority of time. The more factors that point to a single state, the more defensible the domicile determination becomes.
List Accounts and Securities
Enter each account or security holding for which the affidavit is being submitted. Include the financial institution name, account number (or last four digits), type of account, and approximate value. If the transfer agent like Computershare has provided their own form, complete that form instead.
Complete Tax Representations
Confirm that the estate has filed or will file any required state estate tax returns in the domicile state. If applicable, obtain and attach a tax waiver or clearance letter from the state tax authority. Some states such as New York require New York Form TT-141A for domicile determination.
Notarize and Submit
Sign the affidavit before a notary public who administers the oath and applies the notary seal. Submit the notarized original to the transfer agent, brokerage firm, or financial institution that requested it. Keep certified copies for estate records and for filing with any state tax authorities.
Affidavit of Domicile Requirements by State
Affidavit of Domicile laws and requirements differ across states. Key variations include specific language requirements, notarization mandates, witness requirements, filing deadlines, and enforceability standards. Our templates incorporate state-specific provisions when you select your jurisdiction.
For the most comprehensive state-specific version, use our AI generator which automatically applies your state's legal requirements.
Generate state-specific affidavit of domicileFree Template vs Custom Affidavit of Domicile
| Feature | Free Template | Custom (AI or Attorney) |
|---|---|---|
| Basic domicile affidavit format | ||
| Executor certification sections | ||
| State-specific estate tax complianceNY, NJ, MA, etc. | - | |
| Transfer agent-specific language | - | |
| Attorney review and customization | - | |
| Digital download (PDF/Word) |
Affidavit of Domicile Template FAQ
What is an affidavit of domicile?
Who needs an affidavit of domicile?
Who fills out an affidavit of domicile?
Does an affidavit of domicile need to be notarized?
Why do financial institutions require an affidavit of domicile?
What is the difference between domicile and residence?
When is an affidavit of domicile required for stock transfers?
How do you determine domicile for estate tax purposes?
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Attorney-Verified Document: All Legal Tank templates are drafted and reviewed by licensed attorneys to ensure legal accuracy and compliance with current state and federal laws. While our templates meet professional legal standards, individual circumstances vary. We recommend consulting with a licensed attorney in your jurisdiction for complex or high-stakes legal matters. Legal Tank is not a law firm and use of our platform does not create an attorney-client relationship.
Reviewed by licensed attorneys · Editorial policy · Last updated March 2026
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