Certificate of Fact

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Certificate of Fact

Use this form to make a statement of fact.

License plate/Registration number

Vehicle Identification Number (VIN) or Hull Identification Number (HIN)

Model year

Make

Model

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 (city or county) signed

X

Signature

Print completed form and sign here

Printed name of person signing this document

TD-420-043 (R/9/17)WA

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