The shortest form in the Washington set and one of the most useful. Its whole instruction is a single line - use this form to make a statement of fact - and it exists because rule 308-56A-215 lets the department require an affidavit explaining any erasure or alteration on a certificate, an application or a supporting document. When something on the paperwork does not match and there is no dedicated form for it, this is the one.
Written against 420-043 (R/7/26), issued under RCW 46.12.530 and WAC 308-56A-215.
There is no notarisation block on this form, which makes it the exception in a set where almost everything else carries one. That is not an invitation to be casual with it - it is signed under penalty of perjury, and the department is entitled to weigh what it says against what the rest of the paperwork shows.
Two documents, and they are not the same thing. Take the blank 420-043 from the dol.wa.gov copy so you get the revision that is current today.
This is the actual 420-043, rendered from the PDF the Washington State Department of Licensing publishes and completed end to end: letterhead, every field, and the blocks at the foot.
Amber — you write it
Grey — not yours to fill
Numbered — explained below
Three steps and a blank block, filled in. The statement in the middle is the whole document, and it is worth writing it as though a stranger will read it out of context - because that is exactly what happens to it.
Field by field
Every line, in the order you meet it
1
You fill this in
Plate or registration number
The first box of step one.
Watch out: If the vehicle has no plate any more - scrapped, or the plates already surrendered - the registration number goes here instead, and the department can match on it.
2
You fill this in
The identification number
The vehicle identification number, or the hull number for a boat.
Watch out: Take it from the certificate. A statement of fact that carries a different identification number from the record it is meant to explain will not be attached to anything.
3
You fill this in
Model year, make and model
Three boxes completing step one.
Watch out: Use the department's description rather than the manufacturer's marketing name, so the form reads consistently with the record it is about.
4
You fill this in
I certify that
One open block, which is the entire point of the form.
Watch out: Write the fact, the date it happened and the document it affects. A certificate of fact that does not name the document it is explaining leaves the agent to guess.
5
You fill this in
Printed name
Your name, typed or printed, above the perjury declaration.
Watch out: The name here should be the one on the certificate you are explaining - even if that name is the thing you are explaining.
6
You fill this in
Signature, date and place
Print the form, sign it, then the date and the city or county.
Watch out: There is no notary block on this one, so the place-signed box carries more weight than usual: it is what makes this a declaration under the law of Washington.
At a glance
What goes where
On the form
What to put in it
License plate / Registration number
Step 1 of three, and the first of four boxes identifying the vehicle.
Vehicle Identification Number (VIN) or Hull Identification Number (HIN)
One box for either, because the same certificate serves boats.
Model year (yyyy)
Four digits, in the box beside the identification number.
Make and Model
Two boxes finishing the vehicle description.
I certify that
Step 2. A single open block, and the entire substance of the form.
Printed or typed name of person signing this document
Step 3 begins here, above the perjury declaration.
Signature
One line, with the instruction to print the form and sign it.
Date (mm/dd/yyyy) signed and Place (city or county) signed
Two boxes at the very foot.
What gets this one rejected
•A statement that explains nothing. The open block is the form; a certificate of fact reading only 'this is correct' has told the department nothing it did not have.
•A signature typed into the box. The instruction on the line is to print the form and sign it.
•Using it to certify something you do not know. It carries the same declaration under penalty of perjury under the law of Washington as everything else in the set.
•Reaching for it where a proper form exists. A lost title has its own affidavit, an inheritance has its own affidavit, and a certificate of fact is not a substitute for either.
•Leaving the place-signed box empty, which is the box that makes the declaration a Washington one.
Rules that decide whether it is accepted
•Why the department asks for one. The rule lets the department require an affidavit explaining any erasure or alteration on the application, certificate of ownership, or any supporting documentation - and this is the affidavit.
•It cannot rescue an altered certificate on its own. Any alteration or erasure voids the certificate of ownership unless documentation satisfactory to the department goes in with it. A statement of fact is one candidate for that documentation, not a guarantee.
•It is also the form for the small mismatch. A middle initial on the certificate that is not on the driver licence, a body style recorded wrongly years ago, a signature made in a former name - all of them are statements of fact rather than corrections.
•Three steps, and the department numbers them. Vehicle details, the statement, the signature. There is nothing else on the page.
•Newest form in the set. It carries the most recent revision of any form here, and unlike its neighbours it does not print a TD prefix in front of its number.
Every line here was read off 420-043 (R/7/26) itself — the PDF is here — and off the Washington State Department of Licensing pages.
This is plain-language help with a form, not legal advice, and where our wording and the agency's differ,
theirs governs.
