RULE 2106: Affirmation of truth of statement. Complete Form ET-141 if it is claimed that the decedent was not domiciled in New York State at the time of death.Affidavit of Domicile Template - Free download as Word Doc (. Affidavit of Domicile Form. Use our Affidavit of Domicile form to verify the last home address of a deceased person to speed up the inheritance process.