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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.
X
Please sign here after printing if completing this section.
Signature
X
Please sign here after printing if completing this section.
Signature
Printed name (Position and company name if signing for business)
Printed name (Position and company name if signing for business)
WA driver license, ID, or UBI WA driver license, ID, or UBI
Notarization/ Certification for Affidavit of Loss State of
, County of
Signed or attested before me on
(Seal or stamp)
by
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.
X
Please sign here after printing if completing this section.
Signature of person releasing interest
X
Please sign here after printing if completing this section.
Signature of person releasing interest
Printed name (Position and company name if signing for business)
Printed name (Position and company name if signing for business)
WA driver license, ID, or UBI 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.
X
Please sign here after printing if completing this section.
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
(Seal or stamp)
by
Signature
Title
TD-420-040 (R/1/13)WA
Printed or stamped name
and
Dealer or county/office number or notary expiration date
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