STATE OF SOUTH DAKOTA

COUNTY OF [County Name]

Introduction:

I, [YOUR NAME], being duly sworn, hereby declare and affirm under penalty of perjury that:

Statement of Facts:

1. I, [YOUR NAME], born on [Date of Birth], with Social Security Number [Social Security Number], hereby declare my current residence as [YOUR ADDRESS].

2. I can be contacted via phone at [YOUR PHONE NUMBER] and email at [YOUR EMAIL ADDRESS].

3. I hereby declare that my true, fixed, and permanent home and principal establishment, and the place to which I intend to return whenever I depart, is located in the State of South Dakota, specifically at the address stated above.

4. I further declare that I have established and maintained my domicile in South Dakota as of [Date of Domicile].

5. I acknowledge that I own or lease property at the following location(s) outside the State of South Dakota: [List all additional residences].

6. I declare that these additional residences are not my domicile and are maintained only for temporary or seasonal use.

7. This affidavit is executed for the purpose of establishing my South Dakota residency for state income tax purposes and any other legal purposes that require proof of domicile.

Intent:

I affirm that it is my intention to make the State of South Dakota my permanent domicile and to return to South Dakota following any temporary absences.

I understand that providing false information on this affidavit can result in penalties under law. I declare under penalty of perjury that the foregoing is true and correct to the best of my knowledge, information, and belief.

Executed on this [Day] of [Month], [Year] at [ADDRESS].

Signature:

[YOUR NAME]

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

[NOTARY PUBLIC NAME]

Affidavit Templates @ Template.net