Fillable Printable Affidavit of Loss or Release of Interest Template

Affidavit of Loss or Release of Interest Template

The Department of Licensing has a policy of providing equal access to its services.

TD-420-040 (R/7/09)W Page 1 of 2 If you need special accommodation, please call (360) 902-3600 or TTY (360) 664-8885.

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

Instructions

Financial Institutions

If releasing interest on a vehicle sold to a Washington dealer or resident, you can speed up the transfer process by giving

the released title or Afﬁdavit of Loss/Release of Interest to the buyer with a release of interest from the seller (your debtor).

The buyer can then take the documents to any vehicle/vessel licensing ofﬁce and transfer the title.

Odometer Disclosure

A vehicle odometer disclosure is required when transferring a motor vehicle that is nine (9) years old or newer, unless

exempt.

Buyer

You must transfer title within ﬁfteen days of the date of sale.

Seller’s report of sale

The seller must ﬁle a report of sale within ﬁve days of the date of sale, excluding weekends and state holidays, at any

vehicle/vessel licensing ofﬁce for a fee. It can also be ﬁled online at www.dol.wa.gov.

Vehicle owner deceased

The chart below shows what documentation you need to attach to the title application when transferring ownership from

the deceased person. The person who inherits the vehicle/vessel may sell it or keep it. A release of interest is required if

the inheritor is not keeping the vehicle/vessel.

Action taken with assets Documents needed for new title application Legal authority

Legal Action (administered probated,

court ordered)

Certiﬁed letter of testamentary, or

Letter of administration, or

Certiﬁcate of County Clerk TD420-041

WAC 308-56A-335(4a)

WAC 308-93-520(4a)

“Joint Tenants with Rights of

Survivorship” appears on the vehicle

record and title

Certiﬁed copy of death certiﬁcate WAC 308-56A-335(4c)

WAC 308-93-520(4b

Community Property Agreement Certiﬁed copy of death certiﬁcate, and

Copy of community property agreement

WAC 308-56A-335(4c)

WAC 308-93-520(4c)

RCW 26.16.120

Estate not administered Certiﬁed copy of death certiﬁcate, and

Afﬁdavit of Inheritance (release of interest if

required), or afﬁdavit of succession (optional) if the

estate is under $60,000

RCW 11.62.005

RCW 11.62.010

WAC 308-56A-335(4d)

WAC 308-93-520(4d)

The above information is in addition to other documents required for title transfers.

Power of Attorney (POA)

To properly sign by Power of Attorney:

• Printorsignthenameofthepersonorbusinessgrantingpowerofattorney“by”

• Signyournameadding“POA”afteryoursignature.Ifsigningforabusiness,includeyourjobtitleandcompanyname.

Examples:

John Q. Public by Jane C. Doe, POA

Person signing for a business: Business Inc. by Jane C. Doe, POA

Business signing by POA for another business: Business Inc. by Jane C. Doe, POA, V.P. for Business 2 Inc.

Name Change – Person

A person changing their name on a Washington Certiﬁcate of Ownership (title) must submit:

• ThecurrenttitleorAfdavitofLoss,and

• Acopyofthecourtorderauthorizingthenamechangeifthenamechangeisaresultofcourtaction,or

• AnAfdavitofnamechange(foundunderformsatwww.dol.wa.gov).Apowerofattorney(POA)cannotbeusedto

change a person’s name on a title unless speciﬁcally authorized in the POA.

Note:

A person changing their name on the certiﬁcate of ownership does not need to release their interest in the vehicle

in their former name. A title transfer is required when registered owners are added or deleted. Name Change due to

business mergers-contact a local vehicle licensing ofﬁce for assistance.

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