Free West Virginia Affidavit of Domicile Template

West Virginia Affidavit of Domicile

Introduction

I, [YOUR NAME], being duly sworn, depose and state as follows:

Statement of Facts

  1. I am the duly appointed and acting executor of the estate of [DECEASED'S NAME], who passed away on [DATE OF DEATH], and who was a resident of [CITY], West Virginia, at the time of their death.

  2. To the best of my knowledge, information, and belief, [DECEASED'S NAME] was a resident of West Virginia for [NUMBER OF YEARS] years immediately preceding their death.

  3. Attached hereto as Exhibit A is a copy of the Death Certificate of [DECEASED'S NAME], which shows their date and place of death.

  4. Attached hereto as Exhibit B is a list of the stocks owned by [DECEASED'S NAME] at the time of their death, including the number of shares and the issuing company.

Sworn Oath

I hereby declare under penalty of perjury that the foregoing is true and correct to the best of my knowledge, information, and belief.

Executed on [DATE].

[YOUR NAME]

Executor of the Estate of [DECEASED'S NAME]


Notarization

Sworn to and subscribed before me this [DATE].

Notary Public

My Commission Expires: [NOTARY EXPIRATION DATE]

[NOTARY SEAL]

Affidavit Templates @ Template.net