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)

. . . . . . . . .

(printed name)

. . . . . . . . .

(signature)