Fillable Printable Washington Parental Authorization Affidavit
Fillable Printable Washington Parental Authorization Affidavit
Washington Parental Authorization Affidavit
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State of Washington County of
Signed or attested before me on
Signature of notary public or licensing services representative
Title
My appointment expires
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Parental Authorization Affidavit
This affidavit must be signed by the applicant’s parent or legal guardian. In the event the applicant, who is still a minor, has
neither parent nor guardian, an employer’s signature will be accepted. An employer may not sign if parent or guardian has
custody of the applicant. The signature below grants us permission to consider this application. Once granted, parent/ guardian/
employer permission cannot be withdrawn.
I certify that I am the custodial parent legal guardian employer of:
Applicant name (Last, First, Middle)
whose date of birth is and who is applying for:
Month, Day, Year
Instruction Permit Motorcycle Instruction Permit Identification Card
Driver License Motorcycle Endorsement Duplicate Driver License or Instruction Permit
I certify that the above named individual has had at least fifty hours of driving experience, ten of which were at night. A licensed
driver with at least five years experience supervised this driving. To the best of my knowledge, this applicant has not been issued
any traffic infractions or cited for any traffic violations that are pending at the time of this application.
I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct.
Signature of parent/ guardian Date
Driver license or ID card number State
Under the provisions of RCW 46.20.0921 of the Washington State Motor
Vehicle Laws, it is a misdemeanor for any person to use a false or fictitious
name in any application or to knowingly conceal a material fact or otherwise
commit a fraud in any such application. A violation of this provision of the laws
may result in suspension of the driving privilege of those involved.
We are committed to providing equal access to our services.
DLE-520-003 (R/10/10)WEA If you need accommodation, please call (360) 902-3900 or TTY (360) 664-0116.
Driver license/ ID card number
