An unsworn declaration under this chapter must be in substantially the following form:
I declare under penalty of perjury under the law of Washington that the foregoing is true and correct.
Signed on the . . . . day of . . . . . ., . . . .,
(date) (month) (year)
at . . . . . . . . . . . . . . . . . . .
(city or other location, and state or country)
. . . . . . . . .

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(printed name)
. . . . . . . . .
(signature)