An insurer's form, and the reason a written-off car stops being your problem. Its first line names its author: insurance companies use this form to notify us within 15 days of settling a total loss claim on a vehicle. A seller reads it to understand what the insurer is telling the department about the vehicle - and in particular the single yes-or-no answer that decides whether the record ends up carrying a WA rebuilt brand.
Written against 420-074 (R/7/21), issued under RCW 46.04.514 and RCW 46.12.600.
If your insurer has settled a total loss and taken the car, a Report of Sale is still worth filing - the department's own list of things you must report includes turning a vehicle over to an insurance company. The insurer's form and your report answer different questions and neither substitutes for the other.
Two documents, and they are not the same thing. Take the blank 420-074 from the dol.wa.gov copy so you get the revision that is current today.
This is the actual 420-074, 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
The insurer's form, filled in as an insurer would file it. The one block worth a seller's attention is at the very bottom: a single yes-or-no answer that decides whether the vehicle's record ends up carrying a rebuilt brand for the rest of its life.
Field by field
Every line, in the order you meet it
1
The lienholder fills this in
The vehicle band
Plate number and state, identification number, model year, make and model.
Watch out: The plate state matters here - a total loss settled in Washington on a vehicle plated elsewhere is still reportable, and the form has a box for it.
2
The lienholder fills this in
Registered owner
Your name and address, as the department holds them.
Watch out: This is the block that ties the settlement to your record. If it is wrong, the write-off attaches to somebody else's vehicle history.
3
The lienholder fills this in
Legal owner
A lender if there is one, or the word SAME.
Watch out: Where a loan is outstanding the settlement usually goes to the lender first, and this box is what tells the department to expect that.
4
The lienholder fills this in
Status: retained, retained by the insurer, or sold
Three ticks describing what happens to the wreck.
Watch out: Retained by owner is the tick that leaves you holding a vehicle you now have to deal with. It is worth knowing which box was ticked before the cheque clears.
5
The lienholder fills this in
The insurer's own details
Company, named representative, address and a ten-digit telephone number.
Watch out: The named representative is the person to ask if the department's record does not update. There is nobody else on the form to ring.
6
The lienholder fills this in
Claim number and the three dates
File or claim number, date of loss, settlement date and today's date.
Watch out: The fifteen-day clock runs from the settlement date, not from the crash. Those two can be months apart.
7
The lienholder fills this in
The market value threshold question
One yes-or-no answer to a three-part test about the vehicle's type, age and value.
Watch out: Leaving it blank is not neutral. The form warns that an unanswered question may result in a WA REBUILT brand on the record.
At a glance
What goes where
On the form
What to put in it
Plate number, State, identification number, Model year, Make, Model
The vehicle band across the top.
Registered owner name and address
You, as the department has you on the record.
Legal owner name and address
A lender if there is one, with the instruction to enter SAME unless different from registered owner.
Status: Retained by owner / Retained by insurance company / Sold
Three ticks, and they describe three quite different futures for the vehicle.
Name of insurance company and its representative
Who is filing, and the person at the insurer who can be rung about it.
Insurance company address
One block.
File or claim number
The insurer's own reference.
Date of loss, Settlement date, Today's date
Three dates. The fifteen-day clock runs from the settlement date.
Market value threshold - the salvage vehicle question
A single yes-or-no answer to a three-part test: whether the vehicle is a passenger car, light-duty truck of 12,000 pounds gross weight or less, or sport utility vehicle; whether it is 6-20 years old; and whether it meets the current market value threshold.
The consequence of not answering
Printed under the question: if you do not mark the Yes or No box, the vehicle record may result in a WA REBUILT brand.
What gets this one rejected
•A part-completed form. The instruction is printed on it: this form is not valid unless fully completed.
•An unanswered market value question, which the form warns may brand the record.
•A seller filing it. Only an insurance company or self-insurer files this one.
•Sending it to a licensing office. It goes to the Insurance Destroyed Desk at the department in Olympia.
•Filing it late. The statutory window is 15 days after the settlement of the claim, wherever the loss occurred.
Rules that decide whether it is accepted
•The insurer has three ways to report. Electronically through the department's online reporting system, by sending in the certificate marked DESTROYED, or by submitting this completed settlement form. An insurer using the electronic route must immediately destroy the ownership documents afterwards.
•The threshold moves, which is why the form does not print it. The figure is set in statute as a floor and the department raises it by rule whenever the consumer price index for the west region shows an annual average increase in the used cars and trucks category, rounded to the nearest ten dollars and only where the increase would be fifty dollars or more. The form carries no number at all - it says to visit the department's site for the current market value threshold.
•Age is worked out by subtraction. The statute defines the vehicle's age as the current calendar year less the model year - which is why a car can move in or out of the six-to-twenty band on 1 January.
•The owner has a duty too, and it is separate. The registered or legal owner must report destruction within 15 days and send in the certificate marked DESTROYED. It is a gross misdemeanor to be holding a destroyed vehicle's certificate on the sixteenth day.
•Transferring to an insurer does not need a notary. The statute says supporting documents used to transfer ownership to an insurer after payment of damages do not require a notarized signature, may be signed electronically, and may be printed on hard copy.
Every line here was read off 420-074 (R/7/21) 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.
