Junk Vehicle Afdavit
Law enforcement ocers and authorized junk vehicle inspectors use this form to certify that an abandoned
vehicle qualies as a junk vehicle. Landowners use this form to notify the last owner (if known) of the vehicle, to
certify that the vehicle owner was notied and has not redeemed the vehicle, and as an ownership document
for retitling, selling, or disposing of the vehicle. Contact a law enforcement agency or an authorized junk vehicle
inspector to arrange for inspection of the vehicle.
To qualify as a junk vehicle, the vehicle must meet three of the following conditions:
• Must be at least three years old
• Must be extensively damaged
• Must be apparently inoperable
• Must have a fair market value equal only to the approximate value of the scrap of the vehicle
Law enforcement ofcer or authorized junk inspector
PRINT or TYPE Landowner name (Area code) Phone number
Street address where vehicle is located
City State ZIP code Public property If “Yes” requesting agency
Landowner mailing address (if dierent from the street address of the property where the vehicle is located)
City State ZIP code
License plate number State Year Make
Vehicle Identication Number (VIN)
Registered owner name (if no owner is found, enter “none”)
Registered owner street address
City State ZIP code
Legal owner name (if no owner is found, enter “none”)
Legal owner street address
City State ZIP code
Law enforcement ocer or authorized junk inspector name
Badge or personnel number Law enforcement agency or department name
Yes No
X
Check to indicate damaged or missing parts:
A Engine
B Transmission
C Front axle
D Rear axle
E Right front seat
F Left front seat
G Rear seat
H Front bumper
I Rear bumper
J Grill
K Hood
L Right front fender
M Left front fender
N Windshield
O Right front door
P Right rear door
Q Right rear fender
R Left front door
S Left rear door
T Left rear fender
U Rear window
V Trunk lid
I have inspected the vehicle described above and certify that it qualies as a junk vehicle.
Law enforcement ocer or authorized junk vehicle inspector signature Date
TD-420-549 (R/5/20)WA Page 1 of 2
Click here to START or CLEAR, then hit the TAB button
Law enforcement: When completed, print this out and sign here.
Notary or agent
State of County of
Signed or attested before me on by
Print name of person signing this adavit of sale
(Seal or stamp)
Signature of Notary/Agent
Print or stamp name of Notary/Agent
and
Notary/Agent title
Dealer or county/oce number or notary expiration date
X
Vehicle owners rights
Y
ou have ou have the right to arrange to remove your vehicle from the property where it is located within 15 days after
the date this form was mailed to you. If you do not remove your vehicle, the owner of the property may dispose
of it or may sign an Adavit of Sale to be used as an ownership document to sell or retitle it.
Landowner
To request an abandoned junk vehicle inspection you must be the legal owner or person with possession or control of,
or the public ocial with jurisdiction over,
the property where the vehicle described on page one of this form is located.
Mail a copy of this entire form to both the registered and legal owner(s)
of the vehicle described on page 1
,
or
if no owner information was found, check the proper box below
.
Check one:
I mailed a copy of this Junk Vehicle Disposal Adavit to the registered and legal owners of the vehicle
more than 15 days ago and the owners have not redeemed the vehicle.
No registered or legal owners information could be found.
I declare under penalty of perjury under the law of Washington that the foregoing is true and correct.
Date and place Landowner signature
If the vehicle remains unclaimed more than 15 days after you have mailed notication to the owners or if no
owner information could be found:
• Sign the Adavit of Sale below for use as an ownership document and have it notarized.
• You may make arrangements to remove the vehicle.
• You are entitled to recover all costs of the removal of the junk vehicle from the vehicle owner.
Afdavit of Sale – Complete this section for use as an ownership document when you retitle or sell the vehicle.
Purchaser name
Purchaser street address, City, State, ZIP code
Landowner signature Date
Afdavit of Destruction/Disposal – Complete this section to document when you dispose of a junk vehicle.
Wrecker/Disposal business name UBI number
Wrecker/Disposal street address, City, State, ZIP code
Date of delivery to disposal site
Person disposing/landowner signature
If you intend to operate this vehicle after completion of repairs, this form and the vehicle must be taken to the
Washington State Patrol (WSP) for inspection. A separate WSP inspection form must be included with your title
application.
RCW 46.55.010; 46.55.230
TD-420-549 (R/5/20)WA Page 2 of 2
X
X
X
Landowner: When completed, sign here.
Landowner: When completed, sign here.
Person disposing/landowner: When completed, sign here.