Affidavit of Domicile at Death
AFFIDAVIT OF DOMICILE AT DEATH
Before you use this: Ask the recipient whether it accepts this affidavit, requires its own form, or needs a certified death certificate or other records. For a Massachusetts Probate and Family Court filing, use the court's official MPC 485 form when required. Complete only facts you can support from personal knowledge or identified records. Sign before an authorized officer who can administer the oath or affirmation.
Recipient: [COURT, TRANSFER AGENT, FINANCIAL INSTITUTION, OR OTHER RECIPIENT]
Matter, estate, or account number: [________________________________]
State of [STATE]
County of [COUNTY]
I, [AFFIANT'S FULL LEGAL NAME], being duly sworn or affirmed, state:
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I am [RELATIONSHIP TO DECEDENT AND, IF APPLICABLE, CAPACITY AS PERSONAL REPRESENTATIVE OR OTHER AUTHORIZED PERSON]. My mailing address is [STREET, CITY, STATE, ZIP].
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[DECEDENT'S FULL LEGAL NAME] died on [__/__/____]. The place of death was [CITY, STATE OR COUNTRY]. The death certificate is [ATTACHED AS EXHIBIT A / AVAILABLE TO THE RECIPIENT SEPARATELY / NOT AVAILABLE].
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On the date of death, the decedent's domicile was [STREET ADDRESS, CITY, COUNTY, STATE OR COUNTRY, ZIP]. The decedent had lived there since approximately [__/__/____]. If the decedent was temporarily away from that address at death, the location and reason were [DESCRIBE, OR “NOT APPLICABLE”].
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I know the facts in paragraph 3 because [EXPLAIN PERSONAL KNOWLEDGE, YOUR RELATIONSHIP, HOW OFTEN YOU OBSERVED THE DECEDENT'S HOME, AND WHEN].
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The following records support the address or the decedent's connection to it. I have identified each record and its date; I am not claiming to have personal knowledge of a record's contents beyond what I state here:
| Exhibit or separately supplied record | Issuer, date, address shown, and what it supports |
|---|---|
| [EXHIBIT B / NONE] | [________________________________] |
| [EXHIBIT C / NONE] | [________________________________] |
| [EXHIBIT D / NONE] | [________________________________] |
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Other places where the decedent maintained a residence during the year before death, if any, were [ADDRESS, DATES, AND PURPOSE / NONE KNOWN]. Facts bearing on which place the decedent treated as a continuing home are [DESCRIBE FIRSTHAND STATEMENTS OR CONDUCT AND IDENTIFY THEIR SOURCE].
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I am aware of [NO CONTRARY INFORMATION / DESCRIBE ANY CONTRARY INFORMATION, SUCH AS A DIFFERENT ADDRESS ON A CURRENT RECORD, AND EXPLAIN IT]. If I do not know a fact requested above, I have marked it unknown rather than guessing.
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I make this affidavit for [SPECIFIC PURPOSE AND RECIPIENT]. The factual statements above are true to my personal knowledge except where I identify a record or another source. I understand that this affidavit does not itself transfer an asset, appoint a personal representative, or resolve a disputed domicile.
Affiant's signature: [________________________________]
Printed name: [________________________________]
Date signed: [__/__/____]
Contact address: [________________________________]
Phone or email: [________________________________]
Notarial certificate
The notarial officer shall complete or attach the certificate required for an oath or affirmation in the place of notarization.
Officer's signature, title, and seal, or attached certificate: [________________________________]
Official sources
About this template
- Last updated
- October 13, 2026
- Last reviewed
- October 13, 2026
- Jurisdiction
- All states
- Category
- Estate Planning & Wills
Estate planning documents decide what happens to your property, your children, and your medical care when you cannot make those decisions yourself. Wills, trusts, powers of attorney, and health care directives each serve different purposes and each have to meet state law requirements for signing, witnessing, and notarization. A document that looks fine on the page but was not executed correctly can be rejected in probate, which is exactly when it is too late to fix.
Not legal advice
This template is provided for informational purposes. We recommend having an attorney review any legal document before signing, especially for high-value or complex matters.
Checked against the law it cites
A reviewer verified this template's legal citations against the official source on October 13, 2026.
Texas Secretary of State, Notary Public Educational Information (checked October 13, 2026): "A voluntary declaration of facts, written down and sworn to or affirmed by the declarant ("affiant") before a Notary Public or other officer having the authority to administer an oath."
Massachusetts Probate and Family Court, Affidavit of Domicile (MPC 485) (checked October 13, 2026): "Probate & Family Court form for use in informal probate, formal probate, late and limited probate, or voluntary administration."
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