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Certificate of Fact
Use this form to make a statement of fact.
License plate/Registration number Year
Make
Series/Body style
Vehicle Identification Number (VIN) or Vessel Hull Identification Number (HIN)
I certify that
I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct.
Date and place
X When completed, print this out and sign here.
Signature
Notarization/Certification
State of Signed or attested before me on
, County of 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-420-043 (R/8/11)WA
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