Purpose: To request domicile verification from a nonrelative who is familiar with the household's situation. Please list all of the persons living in the home, including the client named on the front of this form: Name.Relationship to Client. To help us to correctly evaluate the household's situation, we need your assistance. To establish a new domicile, you need 1) a physical presence, and 2) a truthful, concurrent, intent of making the new state your permanent place of abode. This form is used to verify housing information for Texas Health and Human Services. 1. Collect all necessary documentation supporting your domicile claim. Complete an Affidavit of Domicile form. Besides filling out this form, the individual must provide two acceptable documents to support their claim of domicile. How Do I Fill Out an Affidavit of Domicile?