WASHINGTON STATE DEPARTMENT OF
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.
Date and place Signature
State of , County of
Signed or attested before me on by
(Seal or stamp)
Printed or stamped name
Dealer or county/ofﬁce number or notary expiration date
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