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2. Name*
3. Email Address*
5. Address*
7. City*
8. State*
9. Zip Code*
11. Phone Number*
12. Alternate Number*
14. Date
    Date
18. Attach 2022 Vehicle Licensing Registration/Receipt*
20. WA State Vehicle License Plate Number**

22. **Please allow 4-6 weeks for refund processing and delivery to address listed above**

24. 
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26. 1. Receive an email copy of this form.
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