Affidavit of Domicile, Verify the state of residence of a deceased individual. If the Decedent had more than one residence, the domicile is that place where the Decedent intended to return.Complete Form ET-141 if it is claimed that the decedent was not domiciled in New York State at the time of death. Fill in the name of the decedent at the top. 2.2. RULE 2106: Affirmation of truth of statement. Kindly fill the form and click the 'Save as PDF' Button. The 'RESET' Button clears all the fields you have filled-in, so you can start over.