I, __________________________________________________, a tenant at the dwelling unit located at ____________________________________, Vancouver, WA, hereby designate ___________________________________________________, as the person to act on my behalf pursuant to RCW 59.18.590 in the event that I am the sole occupant of the premises on the date of my death.

My designated person’s mailing address, phone number and address used for the receipt of electronic communications are:

Designated person’s mailing address: ______________________________________________________________

Designated person’s telephone number: ______________________________________________________________.

Designated person’s address for electronic communications: ____________________________________________.

In the event of my death and if at such time I am the sole occupant of the dwelling unit, my designated person is allowed to: a) have access to the dwelling unit, b) remove my personal property, c) receive refunds of amounts due me from my landlord, and d) dispose of my property consistent with my last will and testament and any applicable intestate succession law.

I understand that this designation will remain in effect until I revoke it or replace it with a new designation.

Dated: ______________________

_____________________________________________________, tenant

(The above should not be construed as specific legal advice and is intended for general information purposes only)