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Affidavit of Domicile Form

An affidavit of domicile is completed by a beneficiary who has inherited shares of stock. The affidavit notifies the investment company that the original investor has died and the beneficiary is now the owner of the shares. This is usually accompanied by a copy of a death certificate.
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How Do You Get a Death Certificate?

A death certificate can be obtained at the local county records office (where the person died) or at the state’s Bureau of Vital Statistics office.

By Type (4)


AST Financial

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Charles Schwab

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Merrill Lynch

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TD Ameritrade

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Sample

AFFIDAVIT OF DOMICILE

State of [STATE]

County of [COUNTY]

Date: [DATE]

I. CLAIMANT.

I, [CLAIMANT NAME] (“Claimant”), with a mailing address of [ADDRESS], declares to be the Decedent’s:

(check one)

– Executor / Administrator of the Estate

– Spouse

– Beneficiary

– Surviving Joint Tenant

– Other. [DESCRIBE OTHER]

II. DECEASED.

[DECEDENT NAME] (“Decedent), with a mailing address of [ADDRESS], who died on [DATE].

III. PURPOSE.

The purpose of this Affidavit is to retrieve transfer and take possession of the following accounts and property: [DESCRIBE]

Claimant’s Signature: ____________________ Date: ______________

Print Name: _________________________ Date: ______________