X X Off-Road Motorcycle Highway Use Declaration Use this form to certify and register a 2-wheeled, off-road motorcycle for highway and public roadway use. This applies to motorcycles originally labeled by the manufacturer as off-road use only. Any off-road motorcycle having more than 2 wheels is not eligible for this certification. For additional information, visit dol.wa.gov. The operator of the motorcycle must have a valid Washington driver license and motorcycle endorsement. To register your off-road motorcycle for highway and public roadway use, you must: • Have your motorcycle inspected by a licensed Washington motorcycle dealer or repair shop. • Have the dealer or repair shop fill out Section 1 and attach the inspection fee receipt. • Complete Section 2 and take this form and ownership documents to any vehicle licensing office. Section 1 – Dealer or repair shop – Complete and sign.You are entitled to an inspection fee up to $100. It must be paid directly to you. Attach a copy of the receipt showing amount charged. PRINT or TYPE Business name Unified Business Identification (UBI) number Address (Address, City, State, ZIP code) (Area code) Telephone number Email Vehicle Identification Number (VIN) Model year Make Model Inspection items Headlight ..... Pass Fail Tail light....... Pass Fail Brake light ..... Pass Fail Turn signals . . . Pass Fail Reflectors .......... Pass Fail Horn .............. Pass Fail Mirror (left or right) ... Pass Fail Brakes ............ Pass Fail Tires ................... Pass Fail Fenders ................ Pass Fail Windshield (if applicable) ... Pass Fail NOTE: All items must pass inspection to register this motorcycle. Certification 1. Did you verify the vehicle identification number (VIN) or engine serial number? ....................... Yes No 2. Is the motorcycle properly equipped with all items required by RCW 46.61.705(2)(a) through (k)? ........ Yes No 3. Does the equipment you inspected comply with state and federal requirements? ..................... Yes No I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct. If signing for a business, I have full authority to do so. Date and place (city or county) signed Authorized signature Section 2 – Registered owner – If you remove any of the above equipment from yourWATV, it is no longer eligible for public road use and must be registered for off-road use only. PRINT or TYPE Name Washington driver license number Address (Street address, City, State, ZIP code) (Area code) Telephone number Email Certification 1. Do you understand this motorcycle was not manufactured for on-road use and has been modified for use on public roads? .................................................................. Yes No 2. To the extent permitted by law, do you agree to indemnify, defend, and hold harmless the state of Washington, counties, cities, towns, and the Department of Licensing from all claims, damages, losses, expenses, and costs arising out of the registration and operation of this motorcycle? ............ Yes No 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 Signature RCW 46.04.363; 46.09.470; 46.16A.435; 46.61.705 TD-420-808 (R/7/16)WA

Off-Road Motorcycle Highway Use Declaration · X X Off-Road Motorcycle Highway Use Declaration Use this form to certify and register a 2-wheeled, off-road motorcycle for highway and

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Off-Road MotorcycleHighway Use Declaration

Use this form to certify and register a 2-wheeled, off-road motorcycle for highway and public roadway use. This applies to motorcycles originally labeled by the manufacturer as off-road use only. Any off-road motorcycle having more than 2 wheels is not eligible for this certification. For additional information, visit dol.wa.gov.

The operator of the motorcycle must have a valid Washington driver license and motorcycle endorsement. To register your off-road motorcycle for highway and public roadway use, you must:

• HaveyourmotorcycleinspectedbyalicensedWashingtonmotorcycledealerorrepairshop.• HavethedealerorrepairshopfilloutSection1andattachtheinspectionfeereceipt.• CompleteSection2andtakethisformandownershipdocumentstoanyvehiclelicensingoffice.

Section 1 – Dealer or repair shop–Completeandsign.Youareentitledtoaninspectionfeeupto$100.Itmust be paid directly to you. Attach a copy of the receipt showing amount charged.

PRINT or TYPE Businessname UnifiedBusinessIdentification(UBI)number

Address (Address, City, State, ZIP code)

(Areacode)Telephonenumber Email VehicleIdentificationNumber(VIN)

Modelyear Make Model

Inspectionitems

Headlight . . . . . Pass FailTail light. . . . . . . Pass FailBrakelight. . . . . Pass FailTurn signals . . . Pass Fail

Reflectors . . . . . . . . . . Pass FailHorn . . . . . . . . . . . . . . Pass FailMirror(leftorright) . . . Pass FailBrakes . . . . . . . . . . . . Pass Fail

Tires . . . . . . . . . . . . . . . . . . . Pass FailFenders . . . . . . . . . . . . . . . . Pass FailWindshield(ifapplicable) . . . Pass Fail

NOTE:Allitemsmustpassinspectiontoregisterthismotorcycle.Certification

1.Didyouverifythevehicleidentificationnumber(VIN)orengineserialnumber? . . . . . . . . . . . . . . . . . . . . . . . Yes No 2. IsthemotorcycleproperlyequippedwithallitemsrequiredbyRCW46.61.705(2)(a)through(k)? . . . . . . . . Yes No3. Doestheequipmentyouinspectedcomplywithstateandfederalrequirements? . . . . . . . . . . . . . . . . . . . . . Yes No

I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct.If signing for a business, I have full authority to do so.

Dateandplace(cityorcounty)signed Authorizedsignature

Section 2 – Registered owner–IfyouremoveanyoftheaboveequipmentfromyourWATV,itisnolongereligiblefor public road use and must be registered for off-road use only.

PRINT or TYPE Name Washingtondriverlicensenumber

Address (Street address, City, State, ZIP code)

(Areacode)Telephonenumber Email

Certification

1.Doyouunderstandthismotorcyclewasnotmanufacturedforon-roaduseandhasbeenmodified foruseonpublicroads? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No 2. To the extent permitted by law, do you agree to indemnify, defend, and hold harmless the state ofWashington,counties,cities,towns,andtheDepartmentofLicensingfromallclaims,damages, losses,expenses,andcostsarisingoutoftheregistrationandoperationofthismotorcycle? . . . . . . . . . . . . Yes No

I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct.

Dateandplace(cityorcounty)signed Signature

RCW46.04.363;46.09.470;46.16A.435;46.61.705

TD-420-808(R/7/16)WA