New York Non-Domicile Declaration Form

New York Non-Domicile Declaration Form
Use this form to declare that New York is not your domicile and provide supporting information.
Full Name
First NameLast Name
Current Residential Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date of Move from New York (if applicable)
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Previous New York Address (if applicable)
Duration of Residence Outside New York (years/months)
Reason for Declaring Non-Domicile Status
Statement: I declare that New York is not my domicile and the information provided is true to the best of my knowledge.
Signature
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