West Virginia Affidavit of Domicile
Introduction
I, [YOUR NAME], being duly sworn, depose and state as follows:
Statement of Facts
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.
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.
Attached hereto as Exhibit A is a copy of the Death Certificate of [DECEASED'S NAME], which shows their date and place of death.
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]
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