Affidavit of Domicile Re: Estate of_______________________________ __________________________________________ Name of Company or Institution State of New Jersey County of Ocean ss: ___________________________________________________________residing at ______________________________________________________________, being duly sworn, deposes and says: I am the (Executor/rix/Administrator/rix/Survivor in Joint Tenancy) of ____________________________________________________, deceased, who died on _________________________. At the time of death, the domicile (legal residence) of the said decedent was_______________________________________________________and that said decedent resided in the State of New Jersey for _______ years prior to his or her death, and was not a resident of any other State within the United States of America at the time of death. _____________________________________ Subscribed and sworn to before me on ________________________________ ________________________________ Signature & Title of Official My Commission expires_____________ (AFFIX SEAL) American LegalNet, Inc. www.FormsWorkflow.com American LegalNet, Inc. www.FormsWorkflow.com