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Off-Road MotorcycleHighway Use Declaration

Use this form to certify and register a 2-wheeled, off-road motorcycle for highway and public roadway use. This applies to motorcycles originally labeled by the manufacturer as off-road use only. Any off-road motorcycle having more than 2 wheels is not eligible for this certification. For additional information, visit dol.wa.gov.

The operator of the motorcycle must have a valid Washington driver license and motorcycle endorsement. To register your off-road motorcycle for highway and public roadway use, you must:

• HaveyourmotorcycleinspectedbyalicensedWashingtonmotorcycledealerorrepairshop.• HavethedealerorrepairshopfilloutSection1andattachtheinspectionfeereceipt.• CompleteSection2andtakethisformandownershipdocumentstoanyvehiclelicensingoffice.

Section 1 – Dealer or repair shop–Completeandsign.Youareentitledtoaninspectionfeeupto$100.Itmust be paid directly to you. Attach a copy of the receipt showing amount charged.

PRINT or TYPE Businessname UnifiedBusinessIdentification(UBI)number

Address (Address, City, State, ZIP code)

(Areacode)Telephonenumber Email VehicleIdentificationNumber(VIN)

Modelyear Make Model

Inspectionitems

Headlight . . . . . Pass FailTail light. . . . . . . Pass FailBrakelight. . . . . Pass FailTurn signals . . . Pass Fail

Reflectors . . . . . . . . . . Pass FailHorn . . . . . . . . . . . . . . Pass FailMirror(leftorright) . . . Pass FailBrakes . . . . . . . . . . . . Pass Fail

Tires . . . . . . . . . . . . . . . . . . . Pass FailFenders . . . . . . . . . . . . . . . . Pass FailWindshield(ifapplicable) . . . Pass Fail

NOTE:Allitemsmustpassinspectiontoregisterthismotorcycle.Certification

1.Didyouverifythevehicleidentificationnumber(VIN)orengineserialnumber? . . . . . . . . . . . . . . . . . . . . . . . Yes No 2. IsthemotorcycleproperlyequippedwithallitemsrequiredbyRCW46.61.705(2)(a)through(k)? . . . . . . . . Yes No3. Doestheequipmentyouinspectedcomplywithstateandfederalrequirements? . . . . . . . . . . . . . . . . . . . . . Yes No

I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct.If signing for a business, I have full authority to do so.

Dateandplace(cityorcounty)signed Authorizedsignature

Section 2 – Registered owner–IfyouremoveanyoftheaboveequipmentfromyourWATV,itisnolongereligiblefor public road use and must be registered for off-road use only.

PRINT or TYPE Name Washingtondriverlicensenumber

Address (Street address, City, State, ZIP code)

(Areacode)Telephonenumber Email

Certification

1.Doyouunderstandthismotorcyclewasnotmanufacturedforon-roaduseandhasbeenmodified foruseonpublicroads? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No 2. To the extent permitted by law, do you agree to indemnify, defend, and hold harmless the state ofWashington,counties,cities,towns,andtheDepartmentofLicensingfromallclaims,damages, losses,expenses,andcostsarisingoutoftheregistrationandoperationofthismotorcycle? . . . . . . . . . . . . Yes No

I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct.

Dateandplace(cityorcounty)signed Signature

RCW46.04.363;46.09.470;46.16A.435;46.61.705

TD-420-808(R/7/16)WA