The owner of premises, or his or her authorized agent, may initiate the investigation and request the removal of an unauthorized person or persons from the premises by providing to law enforcement a declaration containing all of the following required elements and in substantially the following form:

REQUEST TO REMOVE TRESPASSER(S) FORM

The undersigned owner, or authorized agent of the owner, of the premises located at .......... hereby represents and declares under the penalty of perjury that (initial each box):

(1) [ ] The declarant is the owner of the premises or the authorized agent of the owner of the premises;

(2) [ ] An unauthorized person or persons have entered and are remaining unlawfully on the premises;

(3) [ ] The person or persons were not authorized to enter or remain;

(4) [ ] The person or persons are not a tenant or tenants and have not been a tenant or tenants, or a homeowner or homeowners who have been on title, within the last twelve months on the property;

(5) [ ] The declarant has demanded that the unauthorized person or persons vacate the premises but they have not done so;

(6) [ ] The premises were not abandoned at the time the unauthorized person or persons entered;

(7) [ ] The premises were not open to members of the public at the time the unauthorized person or persons entered;

(8) [ ] The declarant understands that a person or persons removed from the premises pursuant to RCW 9A.52.105 may bring a cause of action under RCW 4.24.355 against the declarant for any false statements made in this declaration, and that as a result of such action the declarant may be held liable for actual damages, costs, and reasonable attorneys' fees;

(9) [ ] The declarant understands and acknowledges the prohibitions in RCW 59.18.230 and 59.18.290 against taking or detaining an occupant's personal property or removing or excluding an occupant from a dwelling unit or rental premises without an authorizing court order;

(10) [ ] The declarant agrees to indemnify and hold harmless law enforcement for its actions or omissions made in good faith pursuant to this declaration; and

(11) [ ] Additional Optional Explanatory Comments:

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A declarant of premises who falsely swears on a declaration provided under this section may be guilty of false swearing under RCW 9A.72.040 or of making a false or misleading statement to a public servant under RCW 9A.76.175, both of which are gross misdemeanors.