Free affidavit of domicile 04
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AFFIDAVIT OF DOMICILE
Re TRANSFER OF SECURITIES

STATE OF WASHINGTON )
) ss.
COUNTY OF KING
)
Martha Washington, being first duly sworn upon oath, declares as follows:
1. Status. I am the surviving spouse of George Washington, who died on August 1, 200
3, at Seattle, King County, Washington.
2. Decedent's Domicile at Death. At his/her death, Decedent:
 Was domiciled at Seattle, King County, Washington;
 Had resided in Washington since 1950; and
 Resided in no other State.
Dated: ____________________
_____________________________
Martha Washington

SUBSCRIBED & SWORN TO before me on: ______________________
_____________________________
Signature of Notary
_____________________________
Printed Name of Notary
NOTARY PUBLIC in and for the State of
Washington, residing at:______________________
My appointment expires on: __________________