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Certicate of Fact

Use this form to make a statement of fact.

License plate/Registration number Vehicle Identication Number (VIN) or Hull Identication Number (HIN)

Model year Make Model

I certify that

I declare under penalty of perjury under the law of Washington that the foregoing is true and correct.

Date and place (city or county) signed Signature

Printed or typed name of person signing this document