COMMONWEALTH OF KENTUCKY

COUNTY OF [COUNTY NAME]

Introduction:

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

Statement of Facts:

1. The decedent, [Full Name of Decedent], who passed away on [Date of Death], was last known to reside at [Full Address].

2. This information is provided to establish the domicile and facilitate the necessary legal and financial processes following their demise.

3. The undersigned affiant, serving in the capacity of [Executor/Administrator/Other] in relation to the decedent, resides at [Your Address].

4. This designation authorizes the affiant to execute this document and undertake actions pertinent to the administration of the decedent's estate, in accordance with the laws and regulations of the Commonwealth of Kentucky.

5. I hereby affirm that, to the best of my knowledge and belief, the decedent was a legal resident and domiciled in the Commonwealth of Kentucky, specifically in [County Name], at the time of their death.

6. This affidavit is executed for the purpose of transferring the ownership of stocks, bonds, or securities owned by the decedent to the rightful heirs or beneficiaries as per the decedent’s last will and testament or applicable Kentucky law, if no will exists.

Legal Acknowledgement:

I understand that this Affidavit of Domicile is being provided to [Financial Institution/Brokerage Name] and, if applicable, other financial institutions and legal entities, to facilitate the transfer of the aforementioned assets and acknowledge my obligation to provide true and accurate information.

Further Affirmation:

I further affirm that I have assumed the responsibility to act in accordance with the laws of the Commonwealth of Kentucky as the [Executor/Administrator] of the decedent’s estate and will distribute the assets of the estate to the rightful heirs or beneficiaries.

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

Executed this [Day] of [Month], [Year].

Signature:

[YOUR NAME]

Subscribed and sworn to before me this [Day] of [Month], [Year].

[Notary Public Name]

[Seal]

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