Affidavit of Domicile - Pennsylvania

Pennsylvania · Fillable PDF · Free

Transfer agents and brokerages ask for this sworn statement before they move stocks, bonds or accounts out of a deceased person’s name. It confirms where the person lived at death, which tells them which state’s tax and probate rules apply. Transfer agents and brokerages ask for this sworn statement before they move stocks, bonds or accounts out of a deceased person’s name.

Serving Pennsylvania. Appointments require a Pennsylvania-commissioned notary.

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Who this form is for

  • Transfer agents and brokerages ask for this sworn statement before they move stocks, bonds or accounts out of a deceased person’s name. It confirms where the person lived at death, which tells them which state’s tax and probate rules apply.

What you'll need

  • The original Affidavit of Domicile - Pennsylvania packet and its instructions.
  • The names, dates and supporting records identified in this packet.
  • Acceptable identification if a notarial act is requested; arrange any required qualified witnesses.

How to complete it

  1. Identify yourself and your role Executor, administrator, heir, or surviving joint owner.
  2. Enter the decedent’s domicile The permanent home address at the time of death.
  3. List the assets Use the issuer name, account or certificate numbers, and share counts from the statement.
  4. Swear to it before a notary Bring a current photo ID. Many transfer agents also require a Medallion signature guarantee, which a notary cannot provide.

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These forms are a free convenience, not legal advice. First Choice Mobile Notary & Apostille is not a law firm. Consult an attorney licensed in the relevant state for legal questions.

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