(1)(a) An adult person, a parent or guardian acting on behalf of a minor, or a guardian acting on behalf of an individual subject to guardianship as defined in RCW
11.130.010, (b) any election official as described in RCW
9A.46.020 or
9A.90.120 who is a target for threats or harassment prohibited under RCW
9A.46.020 or
9A.90.120(2)(b) (iii) or (iv), and any person residing with such person, (c) any criminal justice participant as defined in RCW
9A.46.020 who is a target for threats or harassment prohibited under RCW
9A.46.020(2)(b) (iii) or (iv) and any criminal justice participant as defined in RCW
9A.90.120 who is a target for threats or harassment prohibited under RCW
9A.90.120(2)(b) (iii) or (iv), and any person residing with such person, and (d) any protected health care services provider, employee, or an affiliate of such provider, who provides, attempts to provide, assists in the provision, or attempts to assist in the provision of protected health care services as defined in RCW
7.115.010, and any family members residing with such person, may apply to the secretary of state to have an address designated by the secretary of state serve as the person's address or the address of the minor or incapacitated person. The secretary of state shall approve an application if it is filed in the manner and on the form prescribed by the secretary of state and if it contains:
(i) A sworn statement, under penalty of perjury, by the applicant that the applicant has good reason to believe (A) that the applicant, or the minor or incapacitated person on whose behalf the application is made, is a victim of domestic violence, sexual assault, trafficking, or stalking and that the applicant fears for the applicant's safety or the applicant's children's safety, or the safety of the minor or incapacitated person on whose behalf the application is made; (B) that the applicant, as an election official as described in RCW
9A.46.020 or
9A.90.120, is a target for threats or harassment prohibited under RCW
9A.46.020 or
9A.90.120(2)(b) (iii) or (iv); (C) that the applicant, as a criminal justice participant as defined in RCW
9A.46.020, is a target for threats or harassment prohibited under RCW
9A.46.020(2)(b) (iii) or (iv), or that the applicant, as a criminal justice participant as defined in RCW
9A.90.120 is a target for threats or harassment prohibited under RCW
9A.90.120(2)(b) (iii) or (iv); or (D) that the applicant, as a protected health care services provider, employee, or an affiliate of such provider, who provides, attempts to provide, assists in the provision, or attempts to assist in the provision of protected health care services as defined in RCW
7.115.010, is a target for threats or harassment prohibited under RCW
9A.90.120 or
9A.46.020;
(ii) If applicable, a sworn statement, under penalty of perjury, by the applicant, that the applicant has reason to believe they are a victim of (A) domestic violence, sexual assault, or stalking perpetrated by an employee of a law enforcement agency, (B) threats or harassment prohibited under RCW
9A.90.120(2)(b) (iii) or (iv) or
9A.46.020(2)(b) (iii) or (iv), or (C) threats or harassment as described in (a)(i)(D) of this subsection;
(iii) A designation of the secretary of state as agent for purposes of service of process and for the purpose of receipt of mail;
(iv) The residential address and any telephone number where the applicant can be contacted by the secretary of state, which shall not be disclosed because disclosure will increase the risk of (A) domestic violence, sexual assault, trafficking, or stalking, (B) threats or harassment prohibited under RCW
9A.90.120(2)(b) (iii) or (iv) or
9A.46.020(2)(b) (iii) or (iv), or (C) threats or harassment as described in (a)(i)(D) of this subsection;
(v) The signature of the applicant and of any individual or representative of any office designated in writing under RCW
40.24.080 who assisted in the preparation of the application, and the date on which the applicant signed the application.
(2) Applications shall be filed with the office of the secretary of state.
(3) Upon filing a properly completed application, the secretary of state shall certify the applicant as a program participant. Applicants shall be certified for four years following the date of filing unless the certification is withdrawn or invalidated before that date. The secretary of state shall by rule establish a renewal procedure.
(4)(a) During the application process, the secretary of state shall provide each applicant a form to direct the department of licensing to change the address of registration for vehicles or vessels solely or jointly registered to the applicant and the address associated with the applicant's driver's license or identicard to the applicant's address as designated by the secretary of state upon certification in the program. The directive to the department of licensing is only valid if signed by the applicant. The directive may only include information required by the department of licensing to verify the applicant's identity and ownership information for vehicles and vessels. This information is limited to the:
(i) Applicant's full legal name;
(ii) Applicant's Washington driver's license or identicard number;
(iii) Applicant's date of birth;
(iv) Vehicle identification number and license plate number for each vehicle solely or jointly registered to the applicant; and
(v) Hull identification number or vessel document number and vessel decal number for each vessel solely or jointly registered to the applicant.
(b) Upon certification of the applicants, the secretary of state shall transmit completed and signed directives to the department of licensing.
(c) Within 30 days of receiving a completed and signed directive, the department of licensing shall update the applicant's address on registration and licensing records.
(d) Applicants are not required to sign the directive to the department of licensing to be certified as a program participant.
(5) A person who knowingly provides false or incorrect information upon making an application or falsely attests in an application that disclosure of the applicant's address would endanger (a) the applicant's safety or the safety of the applicant's children or the minor or incapacitated person on whose behalf the application is made, (b) the safety of any election official as described in RCW
9A.46.020 or
9A.90.120 who is a target for threats or harassment prohibited under RCW
9A.46.020 or
9A.90.120(2)(b) (iii) or (iv), (c) the safety of any criminal justice participant as defined in RCW
9A.46.020 who is a target for threats or harassment prohibited under RCW
9A.46.020(2)(b) (iii) or (iv) or of any criminal justice participant as defined in RCW
9A.90.120 who is a target for threats or harassment prohibited under RCW
9A.90.120(2)(b) (iii) or (iv), or (d) the safety of any person as described in subsection (1)(a)(i)(D) of this section who is a target for threats or harassment, or any family members residing with such person, shall be punished under RCW
40.16.030 or other applicable statutes.