Transcription of Vessel Title Application - Wa
1 XXXN otarization / 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)12 Vessel Title ApplicationVessel Please type or print plainly Lease For Title purposes onlyHull identification number (HIN)
2 Primary use type Fuel type Model yr MakeModel Vessel type Vessel type Hull material Engine drive Propulsion typeLength (ft) Location of Vessel (Address, City, State, ZIP code)Manufacturer Purchase price Date entered WA Quick Title Historic donation Yes No Yes NoConditions (choose one) Condition 1 means your Vessel is well maintained. considerations may include, but are not limited to: Mechanically sound Minor repairs needed May have additional options added Low to average engine hours Condition 2 means your Vessel is in need of repair. considerations may include, but are not limited to: Areas are worn and faded even after cleanup Major repairs needed Corrosion, dents, cracks, and/or tears evident Higher than average engine hoursRegistered owner For additional owners, see Vessel Title Application Additional Owners, form 420-289A.
3 Owner type ID type Driver license/ID/TIN/EIN/UBI no Expiration date Phone type (Area code) Phone numberRegistered owner full name (Last, First, Middle, Suffix) or Business name Owner date of birthWA primary residence address (if an individual) or WA principal place of business address (if a business) or WA moorage address (if non-resident)Mailing address, if different than above address (Street address or PO Box, City, State, ZIP code)One-time mailing address, if applicable Owner type Ownership Joint tenants w/right ID type Driver license/ID/TIN/EIN/UBI no Expiration date (Area code) Phone number of survivorship (JTWROS) Yes NoRegistered owner full name (Last, First, Middle, Suffix) or Business name Date of birthLegal owner/Lienholder* Fill out if different than registered owner. For additional legal owner/lienholders, see Vessel Title Application Additional Owners, form 420-289A.
4 *Approved lienholder may be added by selling dealer at a later of legal owner/lienholder (Last, First, Middle initial or Business name)Legal owner/Lienholder type ID type Driver license/ID/TIN/EIN/UBI number Expiration date ELT participant Yes NoMailing address (Street address or PO Box, City, State, ZIP code)DealerDealer type Dealer no Dealer name Sale date Delivery date Vehicle status New Used Prev titled Dealer authorized signatureAnyone 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. Signature of registered owner Title , if signing for business Signature of registered owner Title , if signing for business Date and place (city or county) signed Date and place (city or county) signedTD-420-289 (R/5/19)WAI certify that this information is correct.
5 The Vessel is clear of encumbrances except as shown. Any required sales tax has been collected.
