Fillable Printable Affidavit Of Loss/Release Of Interest
Fillable Printable Affidavit Of Loss/Release Of Interest
Affidavit Of Loss/Release Of Interest
Notarization / Certification – You don’t need your signature notarized if you sign in front of a vehicle licensing agent, who can certify your signature.
State of County of
Signed or attested before me on by
Name of person signing this document
Notary/Agent/Subagent signature
Notary printed or stamped name
Title and
Dealer or county/office number or notary expiration date
(Seal or stamp)
X X
X X
Affidavit of Loss/ Release of Interest
When completed, mail or take this form to any vehicle licensing office. If mailing, you must have your signature notarized.
License plate/Registration number Vehicle Identification Number (VIN) or Vessel Hull Identification Number (HIN)
Model year Make Model Body style
Affidavit of loss – Signature must be notarized or certified
Check all that apply
I do not have the following:
Title Registration Tab Decal Plates Metal tag
It is not in my possession because it was:
Destroyed Illegible Lost Stolen Defaced and can no longer be used
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.
PRINT Name
Position and company name, if signing for a business
(Area code) Telephone Washington driver license number
Date and place (city or county) signed
Signature
PRINT Name
Position and company name, if signing for a business
(Area code) Telephone Washington driver license number
Date and place (city or county) signed
Signature
Release of interest – Signature must be notarized or certified
What are you releasing (check all that apply)
I am releasing interest in the following for the vehicle or vessel described above.
Ownership Gross weight license Personalized plate
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
PRINT Name
Position and company name, if signing for a business
(Area code) Telephone Washington driver license number
Date and place (city or county) signed
Signature
PRINT Name
Position and company name, if signing for a business
(Area code) Telephone Washington driver license number
Date and place (city or county) signed
Signature
TD-420-040 (R/2/17)WA
Click here to START or CLEAR, then hit the TAB button
Signature must be notarized or certified
Signature must be notarized or certified
Signature must be notarized or certified
Signature must be notarized or certified
