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Affidavit of Loss/ Release of Interest
License /Registration number Year Make Series and body
Vehicle Identification Number (VIN) OR Vessel Hull Identification Number (HIN) Title number
Affidavit of Loss
The following is not in my possession because it was lost, stolen, destroyed, or mutilated: (Check the applicable box)
Title Registration Tab Decal Plate(s)
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.
_______________________________ _______________________________ ________________
Signature Printed name (Position and company name if signing for business) WA driver license, ID, or UBI
_______________________________ _______________________________ ________________
Signature Printed name (Position and company name if signing for business) WA driver license, ID, or UBI
Notarization/ Certification for Affidavit of Loss
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
Release of interest
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.
_______________________________ _______________________________ ________________
Signature of person releasing interest Printed name (Position and company name if signing for business) WA driver license, ID, or UBI
_______________________________ _______________________________ ________________
Signature of person releasing interest Printed name (Position and company name if signing for business) WA driver license, ID, or UBI
Gross weight license
I authorize this Gross Weight License to be transferred to the new owner and remain with the vehicle described above.
_______________________________ _______________________________ ________________
Signature of person authorizing transfer Printed name (Position and company name if signing for business) WA driver license, ID, or UBI
Notarization/ Certification for Release of Interest and/or Gross Weight transfer
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
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TD-420-040 (R/1/11)W Page 1 of 2 If you need accommodation, please call (360) 902-3600 or TTY (360) 664-0116.
Instructions
Financial Institutions
If releasing interest on a vehicle sold to a Washington dealer or resident, you can speed up the transfer process by giving
the released title or Affidavit of Loss/Release of Interest to the buyer with a release of interest from the seller (your debtor).
The buyer can then take the documents to any vehicle/vessel licensing office and transfer the title.
Odometer Disclosure
A vehicle odometer disclosure is required when transferring a motor vehicle that is nine (9) years old or newer, unless
exempt.
Buyer
You must transfer title within fifteen days of the date of sale.
Seller’s report of sale
The seller must file a report of sale within five days of the date of sale, excluding weekends and state holidays, at any
vehicle/vessel licensing office for a fee. It can also be filed online at www.dol.wa.gov.
Vehicle owner deceased
The chart below shows what documentation you need to attach to the title application when transferring ownership from
the deceased person. The person who inherits the vehicle/vessel may sell it or keep it. A release of interest is required if
the inheritor is not keeping the vehicle/vessel.
Action taken with assets Documents needed for new title application Legal authority
Legal Action (administered probated, Certified letter of testamentary, or WAC 308-56A-335(4a)
court ordered) Letter of administration, or WAC 308-93-520(4a)
Certificate of County Clerk TD420-041
“Joint Tenants with Rights of Certified copy of death certificate WAC 308-56A-335(4c)
Survivorship” appears on the vehicle WAC 308-93-520(4b
record and title
Community Property Agreement Certified copy of death certificate, and WAC 308-56A-335(4c)
Copy of community property agreement WAC 308-93-520(4c)
RCW 26.16.120
Estate not administered Certified copy of death certificate, and RCW 11.62.005
Affidavit of Inheritance (release of interest if RCW 11.62.010
required), or affidavit of succession (optional) if the WAC 308-56A-335(4d)
estate is under $60,000 WAC 308-93-520(4d)
The above information is in addition to other documents required for title transfers.
Power of Attorney (POA)
To properly sign by Power of Attorney:
• Print or sign the name of the person or business granting power of attorney “by”
• Sign your name adding “POA” after your signature. If signing for a business, include your job title and company name.
Examples:
John Q. Public by Jane C. Doe, POA
Person signing for a business: Business Inc. by Jane C. Doe, POA
Business signing by POA for another business: Business Inc. by Jane C. Doe, POA, V.P. for Business 2 Inc.
Name Change – Person
A person changing their name on a Washington Certificate of Ownership (title) must submit:
• The current title or Affidavit of Loss, and
• A copy of the court order authorizing the name change if the name change is a result of court action, or
• An Affidavit of name change (found under forms at www.dol.wa.gov). A power of attorney (POA) cannot be used to
change a person’s name on a title unless specifically authorized in the POA.
Note:
A person changing their name on the certificate of ownership does not need to release their interest in the vehicle
in their former name. A title transfer is required when registered owners are added or deleted. Name Change due to
business mergers-contact a local vehicle licensing office for assistance.
TD-420-040 (R/1/11)W Page 2 of 2
