Fillable dL Certicate of Fact LICENSING Use this form (Inspirus Credit Union)

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dL Certicate of Fact LICENSING Use this form (Inspirus Credit Union)

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dL
WASHINGTON STATE DEPARTMENT OF
• LICENSING
I I I
Certificate of Fact
Use this form to make a statement of fact.
License plate / Registration number Year Make Series / Body style
Vehicle Identification Number (VIN) or Vessel Hull Identification Number (HIN)
I certify that
I certify under penalty of perjury under the laws of the state of Washington
that the foregoing is true and correct.
X
Date and place Signature
Notarization/Certification
State of , County of
Signed or attested before me on by
Signature
(Seal or stamp)
Printed or stamped name
Title
and
Dealer or county/office number or notary expiration date
We are committed to providing equal access to our services.
If you need accommodation, please call (360) 902-3600 or TTY (360) 664-0116.
TD-420-043 (R/8/11)WA
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dL Certicate of Fact LICENSING Use this form (Inspirus Credit Union)

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Completed 5 March 2021

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