Fill and Sign the Domicile 497313653 Form

AFFIDAVIT OF DOMICILE STATE OF MISSISSIPPI COUNTY OF ________ _______________ , being duly sworn, deposes and says that she resides at ____________ , ________ ( ________ County), State of Mississippi, and is Executrix of the Estate of _______________ , deceased; who died at _______________ at ________ , Mississippi, on the ___ day of ________ , 20 ___ ; at the time of his death the domicile (legal residence) of said decedent was at _______________ , ________ , County of ________ , State of Mississippi; decedent resided at such address for _____ years, such residence having commenced in ________ , 20 ___ ; that decedent last voted in the year 20 ___ in ________ County, State of Mississippi; that decedent was retired at the time of his death; that decedent's most recent federal income tax return showed his legal residence as _______________ , __________ , County of ________ , State of Mississippi; that within three years prior to death decedent was not a resident of another State. All debts, taxes and claims against the estate have been paid or provided for; that this affidavit is made for the purpose of the transfer or delivery of property owned by decedent at the time of his death to the person legally entitled thereto under laws of decedent's domicile and any apparent inequality in distribution has been satisfied or provided for out of the other assets in the estate. ______________________________________ _______________ , Executrix SWORN to before me this __________ day of ___________________, 20 ___ . ______________________________________ NOTARY PUBLIC My Commission Expires: ____________________________