Form Td-420-001 - Vehicle Certificate Of Ownership (Title) Application

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Vehicle Certificate of Ownership (Title) Application
Fees
Plate or TPO
Color #1
Color #2
Vehicle Identification Number (VIN)
Filing
Scale weight
Model year
Pwr
Use
Make
Series/Body type
Model ID
Value code
Year
Cycle engine or motor home number
Fleet code
Equip number
MO reg
Reg exp date
Scale weight
Seats
RTA excise tax
License
Declared GWT
Month GWT
GWT expiration
Mileage
Code
Previous title number
State
Special options
Application
County of residence
Purchase price
Tax jurisdiction
Tax rate
DAV
Leased
No title issued
Inspection
NRM
Bonded
Non-roadworthy
USE TAX EXEMPT: Private automobile was purchased and used by me in another
Native American
Reg only
state for a minimum of 90 days while I was a bonafide resident, before I entered
Joint tenants with rights of survivorship
VIN assignment
Washington on
(Must be used in Washington for personal and family transportation only.)
Washington State primary residence street address
GIFT: Donor previously paid Washington State sales/use tax.
Gross weight
or Washington State principal place of business
INHERITANCE: Washington sales/use tax paid by testator.
street address is required on the vehicle record.
Transferred to SPOUSE.
GWT credit
(Attach proof)
For exceptions to this rule, see form TD-420-004.
Sale to INDIAN IN INDIAN COUNTRY. Notarized statement is attached.
For more than two registered or legal owners, please attach additional applications.
Arbitration
New registered owner
Sales/Use tax
Name (Last, First, Middle initial)
License service
Name (Last, First, Middle initial)
Plate
Washington State primary residence street address (if an individual) or Washington State principal place of business street address (if a business)
LPG
Address (continued)
Mailing address (if different than residence address) or exception address
Aquatic weed
Trauma
First owner’s Washington driver license, ID card, or UBI number
Second owner’s Washington driver license, ID card, or UBI number
New legal owner or lienholder – must be filled out if different than the registered owner
Replacement tab
Name (Last, First, Middle initial)
State parks donation
$5
$0
Name (Last, First, Middle initial)
Out of state
Address
Other
Address (continued)
Total fees and tax
First owner’s Washington driver license, ID card, or UBI number
Second owner’s Washington driver license, ID card, or UBI number
Subagent fee
Dealer’s report of sale
WA dealer number
Dealer name
Date of sale
(Do not
include
I certify that this information is correct.
in total)
The vehicle is clear of encumbrances
Date of delivery
Vehicle is:
Dealer’s authorized signature
except as shown. Any required sales tax
X
has been collected.
New
Used
Previously titled
When completed, print this out and sign here.
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
When completed, print this out and sign here.
Date and place
Registered owner signature
Position, if signing for a business
X
When completed, print this out and sign here.
Date and place
Registered owner signature
Position, if signing for a business
Notarization/Certification for registered owner(s) signature
State of
, County of
Signed or attested before me on
by
(Seal or stamp)
Signature
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) 902-3770 or TTY (360) 664-0116.
TD-420-001 (R/11/13)WA

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