STATE OF SOUTH CAROLINA	)
)	IN THE PROBATE COURT
COUNTY OF GREENVILLE	)
) )	AFFIDAVIT OF RESIDENCY (DOMICILE) FOR DECEDENT
IN THE MATTER OF:	)
)	CASE NUMBER:
(Decedent)	)

I understand residency (domicile) for the purpose of estate administration is the place of the Decedent’s home, a place in which he/she was closely connected and would return after being absent, if physically able.

The official death certificate states the residence is not Greenville County, South Carolina?	Yes No

Were you the informant on the death certificate at the time the information was given?	Yes No

Have you checked with DHEC to change the death certificate information?	Yes No

The current address on the Death Certificate is the Decedent’s:

Nursing Home address

Address of a Relative or Friend that Decedent was visiting with or living with due to an advanced illness

Assignment via Armed Forces

Address Decedent was physically located when he/she was hospitalized/died

Prison address

I do not recognize the address on the Death Certificate

Other: ____________________________________________________________________________________

The death certificate information regarding the Decedent’s residence should be the following address: _______________________________________________________________________________________________:

(mark only those choices that apply to this Decedent and mark only those choices known to you of your own personal knowledge)

Address is Decedent’s house/condominium which he/she owns

Address is Decedent’s apartment which he/she rented

Address is that of Decedent’s mobile home which he/she owned

Address is on Decedent’s Voter’s Registration Card

Address is on Decedent’s S. C. Driver’s License, Automobile Registration, U.S. Passport, S. C. ID Card

Address is the same address listed with Social Security Administration and Medicare

Address is on Decedent’s most recent state and/or federal tax return

Address is where Decedent’s surviving spouse, companion, or adult child continues to live

Address is on file with Decedent’s medical providers, insurers, creditors, bank and/or investment accounts

____________________ County Probate Court advised that the estate should be probated in Greenville County

Other: ____________________________________________________________________________________

Based on the foregoing, I affirm that Greenville County, South Carolina, was the residence/domicile of the Decedent.

Executed this_____ day of _______________, 20____.
SWORN to before me this	day of	Signature:
, 20	Print Name:
Address:
Notary Public for South Carolina	Telephone (Work):
My Commission Expires:	(Home):
(Cell):
E-mail:
Relationship to Decedent/Estate: