Fillable Printable Release of Interest/Power of Attorney Form
Fillable Printable Release of Interest/Power of Attorney Form
Release of Interest/Power of Attorney Form
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Notarization/Certification 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
Notarization/Certification 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/ Power of Attorney
Vehicle license plate/ Vessel registration number Vehicle Identification or Hull Identification number (VIN or HIN)
Year Make Series/ Body type Title number
Lienholder’s release of interest – Requires notarization/certification, unless a business entity and release is
submitted with Certificate of Ownership.
Must be accompanied by Certificate of Ownership or completed, notarized/certified,
Affidavit of Loss of Title form TD-420-040.
I/We release all interest in the above described vehicle/vessel.
TYPE or PRINT lienholder/business/company name Title for business/company Signature of person releasing interest
TYPE or PRINT lienholder/business/company name Title for business/company Signature of person releasing interest
Registered owner’s release of interest – Requires notarization/certification (even if notarized below)
I/We release all interest in the above described vehicle/vessel.
TYPE or PRINT registered owner name Signature of registered owner
TYPE or PRINT registered owner name Signature of registered owner
Power of Attorney – Requires notarization/certification (even if notarized above)
To: Title and Registration Services
Department of Licensing
Olympia, Washington
And to whom it may concern
I appoint to act as my attorney-in-fact to sign all papers and documents that
may
be necessary in order to secure, or release, Washington title and/or registration for the vehicle/vessel described above.
I agree to guarantee and save the state of Washington, and the Director of Licensing, from all responsibility for any legal
action which might arise from the issuance of a Washington certificate of title and/or registration for this vehicle/vessel.
TYPE or PRINT name of person granting Power of Attorney Driver license or ID card number Signature of person granting Power of Attorney
TYPE or PRINT name of person granting Power of Attorney Driver license or ID card number Signature of person granting Power of Attorney
We are committed to providing equal access to our services.
TD-420-050 (R/11/13)WA If you need accommodation, please call (360) 902-3770 or TTY (360) 664-0116.
