The unsworn statement must state (1) that it is certified or declared by the person to be true under penalty of perjury, (2) the date and place of its execution, and (3) that it is so certified or declared under the laws of the state of Washington.
The certification or declaration may be in substantially the following form:
I certify (or declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct:
________________
(Date and Place)
_________________
(Signature)
Wash. Gen. R. GR 13