Massachusetts Nonresident Decedent Affidavit

17 Did the decedent ever live in Massachusetts? Yes No. If yes, during what period(s)?
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18 Indicate the address, nature of decedent’s places of residence (e.g., house rented or owned, apartment, hotel or home of relatives or friends) and
lengths of periods outside Massachusetts during the five years preceding death.
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19 Indicate the address, nature of decedent's places of residence and lengths of periods in Massachusetts during the five years preceding death.
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10 Where and in what years did the decedent vote or register to vote during the five years preceding death?
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11 To what state, county or municipality and in what years did the decedent pay a tax on income, real estate, or on intangible property during the last
five years?
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12 For which taxable year did the decedent last file a Massachusetts income tax return? ________________________________________________
13 In what office(s) of the Internal Revenue Service did the decedent file his federal income tax returns during the five years preceding death? What
was stated therein to be the decedent’s residence?
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14 What was the decedent’s occupation in the five years preceding death? ___________________________________________________________
Give name and address of employer. If self-employed, indicate same; if in partnership, give the name and address of the firm and the individual
partners. If decedent owned a business, give details.
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15 Did the decedent make application for a passport within the last five years? Yes No. If yes, give date(s) and place(s) and home address on
application.
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16 Did the decedent at any time during the five years preceding death execute a will, codicil, trust indenture, deed, mortgage, lease or any other
document in which decedent was described as a resident of Massachusetts? Yes No. If yes, describe such document and state what
residence address(es) were set forth therein.
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17 Was the decedent a party to any legal proceeding in Massachusetts during the last five years? Yes No. If yes, what was the tribunal, date
and type of action?
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18 Did decedent belong to any church, lodge, or other social, fraternal or religious club or organization in Massachusetts? Yes No. If yes, give
name, address, positions held, membership status, etc.
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