Affidavit of Domicile, Verify the state of residence of a deceased individual. 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. Print the name of the affiant under the signature block at the end. 2.3. Most forms below are in PDF format and can be viewed and printed using the Adobe Acrobat Reader version 4.0 or higher. 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. Franklin County, Florida, and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.