STATE OF ILLINOIS

COUNTY OF [County Name]

Introduction:

I, [YOUR NAME], being duly sworn, depose and say:

Statement of Facts:

1. I, [YOUR NAME], residing at [YOUR ADDRESS], hereby declare my relationship to the deceased, [Deceased's Name], as [Relationship to the Deceased].

2. [Deceased's Name] passed away on [Date of Death], leaving behind assets and properties that are now subject to transfer and settlement according to the laws applicable in the State of Illinois and possibly other jurisdictions.

3. At the time of death, the decedent was domiciled in the State of Illinois, County of [Deceased's County of Residence], with the address being [Deceased's Address].

4. The decedent owned personal and real property, including securities, within and possibly outside the State of Illinois.

5. It is necessary to establish the domicile of the decedent at the time of death for the purpose of transferring such assets to the duly designated beneficiaries or heirs according to the laws governing such assets.

6. To the best of my knowledge, at the time of death, the decedent was not involved in any legal proceedings that would affect the disposition of their assets in any jurisdiction outside the State of Illinois.

7. This affidavit is executed to provide necessary documentation for tax purposes and to facilitate the transfer of the decedent’s assets to the rightful beneficiaries or heirs, in accordance with the laws of the State of Illinois and any other state where the decedent may have held assets.

Declaration:

I hereby affirm that the statements herein are made to the best of my knowledge, information, and belief, and I understand they are made for the purposes of transferring the decedent's assets to their rightful heirs or beneficiaries.

Signature:

[YOUR NAME]

Subscribed and sworn to before me this [DAY] of [MONTH], [YEAR].

[NOTARY PUBLIC NAME]

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