State of Wisconsin

County of [County Name]

Introduction:

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

Statement of Facts:

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

2. This address represents the decedent's primary and legal residence at the time of their death, as understood and affirmed by the undersigned.

3. The undersigned, serving as the affiant in this matter, declares a relationship to the decedent as [Relationship to the Decedent].

4. The affiant's current residence is listed as [YOUR ADDRESS], with a contact telephone number of [YOUR TELEPHONE NUMBER].

5. This information is provided to establish the affiant's connection to the decedent and to facilitate communication regarding the matters addressed in this affidavit.

Domicile Declaration:

I hereby declare that to the best of my knowledge and belief, at the time of death, the domicile (legal residence) of [Decedent’s Name], hereinafter referred to as the "Decedent," was in the State of Wisconsin, County of [County Name], City of [City Name].

Purpose of Affidavit:

This affidavit is made for the purpose of establishing the domicile of the Decedent in connection with the administration of the Decedent's estate and for no improper purpose.

I understand that this Affidavit will be relied upon by financial institutions, courts, and tax authorities in the course of estate administration.

I understand that making a false statement in this affidavit is subject to penalties for perjury.

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

Signature:

[YOUR NAME]

Sworn to (or affirmed) and subscribed before me this [Day] of [Month], [Year], by [YOUR NAME].

[Notary Public Name]

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