COMMONWEALTH OF MASSACHUSETTS

COUNTY OF [County Name]

Introduction:

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

Statement of Facts:

1. The individual in question, known herein as the Deceased, bore the name [Deceased's Name].

2. The Deceased's journey came to an end on [Date of Death], marking the date of death.

3. At the time of passing, the Deceased resided at [Deceased's Address], which stood as their last known address.

4. This residence is herein affirmed to have been within the jurisdiction of Massachusetts, highlighting the significance of this state as the focal point of subsequent legal and financial considerations pertaining to the Deceased's estate.

5. I, the undersigned, hereby declare my connection to the Deceased as [Relationship to the Deceased], underscoring my position and capacity in relation to the matters herein discussed.

6. My residential address is listed as [YOUR ADDRESS], which serves as my domicile for all intents and purposes related to this affidavit and beyond.

7. This statement of relation and domicile is provided to establish the framework within which my assertions and declarations regarding the Deceased’s estate are to be understood and evaluated.

Statement of Domicile:

I hereby declare that at the time of death, the domicile (legal residence) of [Deceased's Name], herein referred to as the Deceased, was in the State of Massachusetts, County of [County Name], City/Town of [City/Town Name].

Property and Accounts:

The Deceased owned real and/or personal property, including financial accounts, in the State of Massachusetts as well as in other states. Specifically, the Deceased owned [Property and Accounts, Locations].

Tax Filings and Liabilities:

This affidavit is made for the purpose of establishing the domicile of the Deceased in the Commonwealth of Massachusetts to determine the applicable state tax liabilities and requirements for estate settlement.

Further Affiant Sayeth Not:

I affirm that the information provided in this affidavit is true and correct to the best of my knowledge, belief, and understanding.

IN WITNESS WHEREOF, I have hereunto set my hand this [Day] of [Month], [Year].

Signature:

[YOUR NAME]

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

[Notary Public Name]

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