Affidavit of Domicile Template, Free Download 2026
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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 a domicile affidavit 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?
<strong>Executor</strong> 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.
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.
Legal Details: Key Clauses in a Affidavit of Domicile
Affiant Declaration
I, [____________] ("Affiant"), being duly sworn, state under penalty of perjury that the following is true and correct. I am the [executor / administrator / surviving spouse / heir] of the estate of [____________] ("Decedent").
Decedent Information
Decedent: [____________]. Date of Death: [____________]. Social Security Number: [____________].
Domicile Address
At the time of death, the Decedent's domicile and permanent legal residence was: [____________] (street, city, county, state, zip code). The Decedent was domiciled in the State of [_____________] and was not domiciled in any other state or jurisdiction.
Duration of Residency
The Decedent resided at the above address from [____________] until the date of death, a period of approximately [______] years. Prior to that, the Decedent resided at [____________].
Tax Filings
The Decedent filed federal and state income tax returns as a resident of the State of [_____________]. The Decedent's most recent tax returns were filed in [____________].
Voter Registration and Other Indicia
The Decedent was registered to vote in [____________] County, State of [_____________]. The Decedent held a driver's license issued by the State of [_____________]. The Decedent's automobile(s) were registered in the State of [_____________]. The Decedent maintained bank accounts and other financial relationships in [_____________].
Purpose
This Affidavit is made for the purpose of establishing the Decedent's domicile for the transfer of securities, real property, and other assets; for tax purposes; and for any other lawful purpose.
Penalties of Perjury
I declare under penalty of perjury under the laws of the State of [_____________] that the foregoing is true and correct to the best of my knowledge.
Execution and Notarization
Subscribed and sworn to before me on [____________]. [Notary block.]
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.
Related Affidavits Templates
A affidavit of domicile is often used alongside other affidavits documents. Depending on your situation, you may also need:
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 printable affidavit of domicile 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.
Free Template vs Custom Affidavit of Domicile
| Feature | Free Template | Custom (AI or Attorney) |
|---|---|---|
| Free domicile affidavit format | ||
| Executor certification sections | ||
| State-specific estate tax complianceNY, NJ, MA, etc. | - | |
| Transfer agent-specific language | - | |
| Attorney review and customization | - | |
| Printable affidavit of domicile (PDF/Word) |
Key Facts About Affidavit of Domicile Documents
Financial institutions require affidavit of domicile to determine which state estate tax applies.
Domicile differs from residence because person can have multiple residences but one domicile.
Transfer agents like Computershare require affidavit of domicile for deceased shareholder transfers.
Executor or personal representative is responsible for filing affidavit of domicile.
New York Form TT-141A is used for estate tax domicile determination.
Key Legal Terms in a Affidavit of Domicile
When a Free Template Is Not Enough
Free templates cover standard situations, but a professionally drafted affidavit of domicile accounts for state-specific requirements, unusual circumstances, and enforceability considerations that generic forms miss. If your situation involves significant assets, complex terms, or potential disputes, request an attorney-drafted affidavit of domicile with a custom quote based on your situation.
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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