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X Notarization / Certification – You don’t need your signature notarized if you sign in front of a WA vehicle licensing agent, who can certify your signature. State of County of Signed or attested before me on by Name of person(s) signing this document Notary/Agent/Subagent signature Notary printed or stamped name Title and Dealer or county/office number or notary expiration date (Seal or stamp) Repossession Affidavit Lienholders use this form to report repossession of a vehicle or vessel. Take this completed form and a Vehicle Title Application or Vessel Title Application to any vehicle licensing office. Vehicle/Vessel information License plate/Registration number Vehicle identification number (VIN) or Hull identification number (HIN) Model year Make Model Legal owner I, certify under penalty of perjury under the laws Name of legal owner representative of the state of Washington, that I am the Title or position of Name of company or corporation located at Company or corporate address We are the legal owners of this vehicle/vessel now in our possession due to a default on a security agreement. We legally repossessed this vehicle/vessel on , Date of repossession from , Name of registered owner at . Address of registered owner Attached is a transfer of ownership (Vehicle Title Application or Vessel Title Application). We base this on the repossession of the vehicle or vessel. Date and place (city or county) signed Signature of legal owner representative TD-420-042 (R/2/18)WA

Repossession Affidavit - Department of Licensing of person(s) signing this document Notary/Agent/Subagent signature Notary printed or stamped name Title and ... Repossession Affidavit

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Page 1: Repossession Affidavit - Department of Licensing of person(s) signing this document Notary/Agent/Subagent signature Notary printed or stamped name Title and ... Repossession Affidavit

X

Notarization / Certification – You don’t need your signature notarized if you sign in front of a WA vehicle licensing agent, who can certify your signature.

State of County of

Signed or attested before me on by Name of person(s) signing this document

Notary/Agent/Subagent signature

Notary printed or stamped name

Title and Dealer or county/office number or notary expiration date

(Seal or stamp)

Repossession Affidavit

Lienholders use this form to report repossession of a vehicle or vessel. Take this completed form and a Vehicle Title Application or Vessel Title Application to any vehicle licensing office.

Vehicle/Vessel informationLicense plate/Registration number Vehicle identification number (VIN) or Hull identification number (HIN)

Model year Make Model

Legal owner

I, certify under penalty of perjury under the laws Name of legal owner representative

of the state of Washington, that I am the Title or position

of Name of company or corporation

located at Company or corporate address

We are the legal owners of this vehicle/vessel now in our possession due to a default on a security agreement.

We legally repossessed this vehicle/vessel on , Date of repossession

from , Name of registered owner

at . Address of registered owner

Attached is a transfer of ownership (Vehicle Title Application or Vessel Title Application). We base this on the repossession of the vehicle or vessel.

Date and place (city or county) signed Signature of legal owner representative

TD-420-042 (R/2/18)WA