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Declaration of Non-Responsibility (vehicle)

  1. This Declaration may not be used by employers/principals to transfer responsibility to their employees/agents. As a matter of law, a vehicle registered to an employer/principal that is driven by an employee remains in the "care, custody, and control" of the employer/agent and thus, the employer/principal is responsible for the payment of the penalty.
  2. I received the above-referenced Notice of Infraction. At the time of the violation indicated in the Notice of Infraction, the vehicle described in the Notice was:*
    The statement above rebuts the presumption of liability.
  3. I declare under penalty of perjury under the laws of the State of Washington that the information provided in this Declaration is true and correct to the best of my knowledge.
  4. After completing the above, please READ and ELECTRONICALLY SIGN, below.
  5. 1) I understand the court may require verification of the information provided above.
  6. 2) I certify under penalty of perjury under the laws of Washington State that I have read the foregoing statements in the application, know the contents thereof, and believe them to be true and correct. (Perjury is a criminal offense-see Chapter 9A.72 RCW).
  7. Electronic Signature Agreement:*

    By checking the "I agree" box above, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  8. Last name, first name, middle initial

  9. Leave This Blank:

  10. This field is not part of the form submission.