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Washington Affidavit of Loss/Release of Interest

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This document is provided by Washington State Department of Licensing.

Washington Affidavit of Loss/Release of Interest
Washington Affidavit of Loss/Release of Interest
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Affidavit of Loss/ Release of Interest
License/Registration number Year Make Series and body
Vehicle Identification Number (VIN) OR Vessel Hull Identification Number (HIN) Title number
Affidavit of Loss
The following is not in my possession because it was lost, stolen, destroyed, or mutilated:
(Check the applicable box) Title Registration Tab Decal Plate(s)
I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct.
If signing for a business, I have full authority to do so.
Signature Printed name (Position and company name if signing for business) WA driver license, ID, or UBI
Signature Printed name (Position and company name if signing for business) WA driver license, ID, or UBI
Notarization/ Certification for Affidavit of Loss
State of , County of
Signed or attested before me on by
(Seal or stamp)
Signature
Printed or stamped name
Title and
Dealer or county/office number or notary expiration date
Release of Interest
I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct.
If signing for a business, I have full authority to do so.
Signature of person releasing interest Printed name (Position and company name if signing for business) WA driver license, ID, or UBI
Signature of person releasing interest Printed name (Position and company name if signing for business) WA driver license, ID, or UBI
Gross Weight License
I authorize this Gross Weight License to be transferred to the new owner and remain with the vehicle described above.
Signature of person authorizing transfer Printed name (Position and company name if signing for business) WA driver license, ID, or UBI
Notarization/ Certification for Release of Interest and/or Gross Weight Transfer
State of , County of
Signed or attested before me on by
(Seal or stamp)
Signature
Printed or stamped name
Title and
Dealer or county/office number or notary expiration date
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TD-420-040 (R/1/13)WA If you need accommodation, please call (360) 902-3600 or TTY (360) 664-0116.
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Please sign here after printing if completing this section.
Please sign here after printing if completing this section.
Washington Affidavit of Loss/Release of Interest