Printable forms: Affidavit of residence form

Use the following instructions to accurately complete the Affidavit of Residence form:

1. Name of Corporation.
    
2. Social Security number or Taxpayer Identification Number of the deceased shareowner.
    
3. Your name.
    
4. Your address.
    
5. Your relationship to the deceased shareowner (i.e. executor, administrator, survivor in joint tenancy).
    
6. Deceased shareowner's name as it appears on the face of the certificate/ or registration.
    
7. Date of deceased person's death.
    
8. Permanent address of deceased person at the time of death.
    
9. State where deceased person lived at the time of death.
    
10. Number of years deceased person lived in this state.
     
11. Your signature.
     
12. Notary's stamp and signature.