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Vehicle Title Application

Vehicle ? Please type or print plainly

Vehicle identification no (VIN)

Condition

Vehicle type

New Used Choose one

Model year Make

Model

Primary use type

Choose one

Trim Body style

GV Weight Rating

Choose one

Wheels Rental no

Scale wt Fleet

Gross weight Mo GWT Seats Color #1

Choose one

Engine (MC) Motor home/Cycle/WATV eng serial no

Length

Color #2

Choose one

Width Quick title

Yes

For title purposes only

Fuel type

Choose one

Motorcycle style

Choose one

Equip no

Purchase price

Discover pass

Park donation

No Yes No Yes No

Registered owner ? For additional owners, attach sheet with name, driver license/ID/TIN/EIN/UBI number, expiration date, and phone information. Washington primary residence street address or Washington principal place of business street address is required on the vehicle record. For exceptions, see Primary Residence Address Exception, form 420-004.

Owner type

1 Choose one

ID type

Choose one

Driver license/ID/TIN/EIN/UBI no

Registered owner name (Last, First, Middle, Suffix) or Business name

Expiration date

Phone type

Choose one

(Area code) Phone no

Washington primary residence address (if an individual) or Washington principal place of business address (if a business)

Mailing address, if different than residence address (Street address or PO Box, City, State, ZIP code) or exception address

One-time mailing address, if applicable

Paperless renewal option

Notify me by email when it's time to renew my vehicle

Email address

2

Owner type

Choose one

Joint tenants w/right of survivorship ID type

Yes No

Driver license/ID/TIN/EIN/UBI no

Expiration date

Registered owner name (Last, First, Middle, Suffix) or Business name

Phone type

(Area code) Phone no

Choose one

Legal owner/Lienholder ? Fill out if different than registered owner. For additional legal owner/lienholders, attach sheet with name, driver license/ID/TIN/EIN/UBI number, expiration date, and address information.

Name of legal owner/lienholder (Last, First, Middle initial or Business name)

Legal owner/Lienholder type ID type

Driver license/ID/TIN/EIN/UBI no

Choose one

Mailing address (Street address or PO Box, City, State, ZIP code)

Expiration date

ELT participant

Yes No

Dealer

Dealer type

Choose one

Dealer no Dealer name

Sale date

I certify that this information is correct. The vehicle is clear of encumbrances except as shown. Any required sales tax has been collected.

Delivery date

Vehicle status

New Used

Dealer authorized signature

X

Dealer sign here

Prev titled

Anyone who knowingly makes a false statement may be guilty of a felony under state law and upon conviction shall be punished by a fine, imprisonment, or both. I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct.

X Registered owner: Print completed form and sign here. Include title if business.

Signature of registered owner

Title, if signing for business

Enter date and place (city or county) signed

Date and place signed

X

Registered owner: Sign here. Include title if business.

Signature of registered owner

Title, if signing for business

Enter date and place (city or county) signed

Date and place signed

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

State of

County of

Signed or attested before me on (Seal or stam p)

by Name of person signing this document

Notary/Agent/Subagent signature

TD-420-001 (R/10/18)W

Title

Notary printed or stamped name

and Dealer or county/office number or notary expiration date

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