Form TD-420-028 "Abandoned Recreational Vehicle (Rv) Payback" - Washington

What Is Form TD-420-028?

This is a legal form that was released by the Washington State Department of Licensing - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2019;
  • The latest edition provided by the Washington State Department of Licensing;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form TD-420-028 by clicking the link below or browse more documents and templates provided by the Washington State Department of Licensing.

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Download Form TD-420-028 "Abandoned Recreational Vehicle (Rv) Payback" - Washington

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Click here to START or CLEAR, then hit the TAB button
Abandoned Recreational Vehicle (RV)
Payback
If a registered tow truck operator, wrecker, or motor vehicle scrap/salvage processor receives reimbursement, any funds
received from collection activities must be turned over to this Department. Use this form to submit the funds to us.
Send this completed form and a check or money order payable to the Department of Licensing to:
Abandoned RV Program
Department of Licensing
PO Box 9040
Olympia WA 98507-9040
Business information
Business name
License number
UBI number
Business address (Street address, City, State, ZIP code)
(Area code) Telephone number
(Area code) Fax number
Email
Vehicle information
Vehicle Identification Number (VIN)
Year
Make
Model
No VIN
Vehicle type (motorhome, travel trailer, camper)
Plate number
Plate state
Original reimbursement request information
Date of reimbursement request
Towing amount
Storage amount
Dismantle/Disposal amount
Funds collected
Amount collected
Business/Person collected from
Date collected
Reason?
PRINT or TYPE Name
X
Print completed form and sign and date here.
Signature
Date
TD-420-028 (R/10/19)WA
Click here to START or CLEAR, then hit the TAB button
Abandoned Recreational Vehicle (RV)
Payback
If a registered tow truck operator, wrecker, or motor vehicle scrap/salvage processor receives reimbursement, any funds
received from collection activities must be turned over to this Department. Use this form to submit the funds to us.
Send this completed form and a check or money order payable to the Department of Licensing to:
Abandoned RV Program
Department of Licensing
PO Box 9040
Olympia WA 98507-9040
Business information
Business name
License number
UBI number
Business address (Street address, City, State, ZIP code)
(Area code) Telephone number
(Area code) Fax number
Email
Vehicle information
Vehicle Identification Number (VIN)
Year
Make
Model
No VIN
Vehicle type (motorhome, travel trailer, camper)
Plate number
Plate state
Original reimbursement request information
Date of reimbursement request
Towing amount
Storage amount
Dismantle/Disposal amount
Funds collected
Amount collected
Business/Person collected from
Date collected
Reason?
PRINT or TYPE Name
X
Print completed form and sign and date here.
Signature
Date
TD-420-028 (R/10/19)WA