HomeMy WebLinkAboutExtra Hearing Documents - Williamson aWASHINGTON STATE DEPARTMENT OF
LICENSING Registration Certificate
Model Year Make Model Body Style Vehicle identification number(VIN) Scale Weight
1985 GMC SUBURBAN Sport Utility 1G5EC16LOFF501231 5,066
Plate/Tag no Tab/Decal no Primary vehicle use type Issue date Exp date 'e 41 ' ; ' i , ',I F.
AWK0102 M820411 Passenger Vehicle 07/06/2019 05/21/2020 !
Plate/Tag no Tab/Decal No Vehicle use type Issue date Exp date
Gross Weight Gr wt start date Gross weight exp date Fleet no Equip no I
: it I , . . i i
Registered Owner Legal Owner
WILLIAMSON, GARY J Same as Registered Owner
2011 HARRINGTON AVE NE
RENTON WA 98056-2305
Brands/Comments: 11125/1985, BLUE-ALUMINUM/SILVER, Usc Tax Waived-Gift, Display tab on back license plate only-front
plate is still required
Anyone who knowingly makes a false statement may be guilty of a felony under state law and upon conviction shall be
punished by a fine, imprisonment, or both.
I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct and, as
owner or authorized agent of the vehicle, it is free of any claim of lien, mortgage, conditional sale or other security interest of
any person tlx ept the person or persons set forth as legal owners.
X�% `4 X
Signature of regis ed owner Signature of registered owner
Date and place signed Date and place signed
L0073388440
TD-420-802(R112,16)Page 1 of 2
Vehicle Information: AWK0102 1G5EC16LOFF501231 1985 GMC SUBURBAN Sport Utility
Filing Registration Filing $3.00
Registration Dept.of Licensing Service $0.50leiZQQ2r.,4g.,
G`
License Plate Technology $0.25 3 THANK YOU f
Vehicle Weight $45.00
for your business
Registration License $30.00 I
See you next year!
Service Registration Service Fee $5.00 Kent Licensing
253-852-3110
Fee Total: $83.75
Issue Date: 07/06/2019 You can get a copy of this cash/fee receipt detail at www.dol.wa.gov.
Skip a trip—go online www.dol.wa.gov
THIS DOCUMENT IS NOT PROOF OF LEGAL OWNERSHIP
This is your Washington registration certificate and must be carried in the vehicle or vessel that it was issued, or in the towing unit, or on the
operator for personal motorized devices(off road vehicles, snowmobiles and jetskis).Registrations must be signed by the registered owner.
Any person who shall knowingly makes any false statement of a material fact on this document shall be guilty of a felony which is punishable by
a fine or imprisonment or by both such fine and imprisonment.
CHANGE OF ADDRESS: Registered owners may submit a change of address online at dol.wa.gov or at any county auditor or vehicle licensing
office.There is no fee for this service;however,there is a fee for a new registration certificate.
REPORT OF SALE:Vehicle and vessel owners releasing interest must submit a report of sale to the Department of Licensing,county auditor,
or vehicle licensing office within 5 business days of sale or release.You may submit a report of sale at dol.wa.gov OR at any county auditor or
vehicle licensing office (for a fee).
FEDERAL ODOMETER LAW:The Federal Truth in Mileage Act of 1986 requires sellers of motor vehicles less than 10 years old to complete
an odometer disclosure statement upon transfer of ownership, unless the vehicle is specifically exempt from odometer disclosure requirements.
Exemptions are(1)Vehicles 10 years old and older; (2) non-powered vehicles and snowmobiles;(3)vehicles with a declared gross weight over
16,000 pounds;(4)vehicles sold directly by a manufacturer to a federal agency;or(5)a new vehicle before its first retail sale.
WASHINGTON AUTO REPAIR LAW (applies to almost all repairs)entitles customers to: (1)A written estimate for repairs that will cost more
than $100, unless waived or absent face-to-face contact(see item 4 below).(2) Return or inspection of all replaced parts, if requested at time
of repair authorization.(3)Authorize orally or in writing any repairs which exceed the estimated total cost(before sales tax)by more than 10
percent.(4)Authorize any repairs orally or in writing if your vehicle is left with the repair facility without face-to-face contact between you and the
repair facility personnel.(5) A copy of the invoice, listing all work done and parts supplied.A repairman must post a sign notifying customers of
their rights, and cannot put a lien against or keep your vehicle unless a written estimate was given and they have complied with the rest of the
Consumer Protection Act.The Attorney General's office accepts auto repair complaints at atg.wa.gov.
For more information about titling and licensing,call any Washington County Auditor or vehicle licensing office,or visit our website at dol.wa.gov.
ROW 46.12.650, 46.12.655,46.12.665. 46.12.750;46.71
WAC 308-56A-030, 308-56A-525, 308-56A-640
Vessel registration only:
The bottom section is a"mini registration"that you cut out, sign, and carry as proof of registration.Both the full sheet and mini registration must
be signed to be valid.
What do I do with them?
You can carry one in the towing vehicle and the other on the vessel.
Do I have to cut out the mini registration?
No, you can keep it as one sheet, but you must carry it on the vessel and make it available to law enforcement when requested.
Can I laminate the mini registration?
Yes, but only after the registered owner signs it.
TD-4?O-Sc2(Rr12:1 Page 2 2
aWASHINGTON STATE DEPARTMENT OF
LICENSING Registration Certificate
Model Year Make Model Body Style Vehicle identification number(VIN) Scale Weight
1985 GMC SUBURBAN Sport Utility 1G5EC16LOFF501231 5,066
Plate/Tag no Tab/Decal no Primary vehicle use type Issue date Exp date y '1 '
AWK0102 M820411 Passenger Vehicle 07/06/2019 05/21/2020 I i
Plate/Tag no Tab/Decal No Vehicle use type Issue date Exp date f
Gross Weight Gr wt starf date Gross weight exp date Fleet no Equip no , i
k1 ii 1 1 I , .1, 1 1,
Registered Owner Legal Owner
WILLIAMSON, GARY J Same as Registered Owner
2011 HARRINGTON AVE NE
RENTON WA 98056-2305
Brands/Comments: 11125/1985, BLUE-ALUMINUM/SILVER, Use Tax Waived-Gift, Display tab on back license plate only-front ,
plate is still required
Anyone who knowingly makes a false statement may be guilty of a felony under state law and upon conviction shall be
punished by a fine, imprisonment, or both.
I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct and, as
owner or authorized agent of the vehicle, it is free of any claim of lien, mortgage, conditional sale or other security interest of
any person Ix ept the person or persons set forth as legal owners.
X -- • X
Signature of regis ed owner Signature of registered owner
Date and place signed Date and place signed
L0073388440
TD-420-802(R/12/16)Page 1 of 2
Vehicle Information: AWK0102 1G5EC16LOFF501231 1985 GMC SUBURBAN Sport Utility
Filing Registration Filing $3.00
Registration Dept.of Licensing Service $0.50 csiZQS:
G
License Plate Technology $0.25
THANK YOU
Vehicle Weight $45.00
for your business
Registration License $30.00
Service Registration Service Fee $5.00 $ee you next year!
Kent Licensor
253-852-311�
Fee Total: $83.75
Issue Date: 07/06/2019 You can get a copy of this cash/fee receipt detail at www.dol.wa.gov.
Skip a trip—go online www.dol.wa.gov
THIS DOCUMENT IS NOT PROOF OF LEGAL OWNERSHIP
This is your Washington registration certificate and must be carried in the vehicle or vessel that it was issued,or in the towing unit, or on the
operator for personal motorized devices(off road vehicles, snowmobiles and jetskis).Registrations must be signed by the registered owner.
Any person who shall knowingly makes any false statement of a material fact on this document shall be guilty of a felony which is punishable by
a fine or imprisonment or by both such fine and imprisonment.
CHANGE OF ADDRESS: Registered owners may submit a change of address online at dol.wa.gov or at any county auditor or vehicle licensing
office.There is no fee for this service;however, there is a fee for a new registration certificate.
REPORT OF SALE:Vehicle and vessel owners releasing interest must submit a report of sale to the Department of Licensing,county auditor,
or vehicle licensing office within 5 business days of sale or release.You may submit a report of sale at dol.wa.gov OR at any county auditor or
vehicle licensing office(for a fee).
FEDERAL ODOMETER LAW:The Federal Truth in Mileage Act of 1986 requires sellers of motor vehicles less than 10 years old to complete
an odometer disclosure statement upon transfer of ownership, unless the vehicle is specifically exempt from odometer disclosure requirements.
Exemptions are(1)Vehicles 10 years old and older;(2) non-powered vehicles and snowmobiles; (3)vehicles with a declared gross weight over
16,000 pounds;(4)vehicles sold directly by a manufacturer to a federal agency:or(5)a new vehicle before its first retail sale.
WASHINGTON AUTO REPAIR LAW(applies to almost all repairs) entitles customers to: (1) A written estimate for repairs that will cost more
than$100, unless waived or absent face-to-face contact(see item 4 below).(2) Return or inspection of all replaced parts,if requested at time
of repair authorization.(3)Authorize orally or in writing any repairs which exceed the estimated total cost(before sales tax)by more than 10
percent.(4) Authorize any repairs orally or in writing if your vehicle is left with the repair facility without face-to-face contact between you and the
repair facility personnel.(5)A copy of the invoice, listing all work done and parts supplied.A repairman must post a sign notifying customers of
their rights, and cannot put a lien against or keep your vehicle unless a written estimate was given and they have complied with the rest of the
Consumer Protection Act.The Attorney General's office accepts auto repair complaints at atg,wa.gov.
For more information about titling and licensing,call any Washington County Auditor or vehicle licensing office,or visit our website at dol.wa.gov.
RCW 46.12.650, 46.12.655,46.12.665.46.12.750;46.71
WAC 308-56A-030,308-56A-525, 308-56A-640
Vessel registration only:
The bottom section is a"mini registration"that you cut out, sign, and carry as proof of registration.Both the full sheet and mini registration must
be signed to be valid.
What do I do with them?
You can carry one in the towing vehicle and.the other on the vessel.
Do I have to cut out the mini registration?
No,you can keep it as one sheet, but you must carry it on the vessel and make it available to law enforcement when requested.
Can I laminate the mini registration?
Yes, but only after the registered owner signs it.
Tb-120-802%R/12i 1 n)Page 2 r.2
AFTER VISIT SUMMARY C
Gary J. Williamson DoB: 10/17/1944
li 6/30/2019 4:30 PM 9 Overlake Medical Clinics Overlake Center Urgent Care 425-688-5777
Instructions from Karin Pedersen, PA Today's Visit
You saw Karin Pedersen, PA on Sunday
It was a pleasure meeting you today. June 30, 2019.The following issue was
Start antibiotic today.You will take be taking 2 different antibiotics addressed: Cough.
at the same time ----
Follow up with your provider if not improving in 2-3 days. Blood n BMI
Go to the emergency department if worse. Pressure 30.13
136/80
I hope you feel better soon.
Weight Height
Your diagnosis today is �' 210 lb _ 5' 10"
1. Cough Temperature Pulse
9(Oral)9 F ��VI/ 83
Pneumonia is an infection of the lungs usually caused by bacteria,
though some are caused by viruses. Symptoms of pneumonia may g Respiration Oxygen
include fever, chills, cough, colored phlegm, chest pain, and shortness of 20 r1 Saturation
breath. Chest x-rays,and blood and sputum tests help show the extent 95%
of the illness and the best treatment to follow.
Pneumonia due to a bacterial infection requires 1-2 weeks of l Done Today
antibiotic drug treatment. Medicine for cough,fever,and pain may also X-ray Chest PA/AP and Lateral for
be helpful. Get plenty of bedrest, drink a lot of fluids, and avoid Cough
smoking and alcohol. You should start to feel better after 2 days of
A Medications Given
treatment, but full recovery may take several weeks. albuterol (VENTOLIN) last given at
Follow up with your health care provider or the referral provider as 5:11 PM for Cough
instructed. Call sooner or go to the Emergency Room if you develop: ipratropium (ATROVENT) last given at
Increased shortness of breath or chest pain, 5:11 PM for Cough
Coughing up blood,
Repeated vomiting, dehydration, or confusion,
A high fever, over 101 F, after 3 days of treatment.start antibiotics
Your medications have changed today
See your updated medication list for details.
Tx Pick these up at Walgreens Drug Store 06357 -
0 o ISSAQUAH, WA - 6300 E LAKE SAMMAMISH
PKWY SE AT NWC OF LAKE SAMMAMISH PKWY
& ISSAQU
albuterol • azithromycin • benzonatate • cefuroxime •
inhalational spacing device
Address: 6300 E LAKE SAMMAMISH PKWY SE, ISSAQUAH WA
98029-8935
Hours: 24-hours
Phone: 425-369-0265
What's Next
Gary J.Williamson (10/17/1944) • Printed at 6/30/19 5:53 PM Page 1 of 4 WC
f
You currently have no upcoming appointments scheduled.
If there are any pending labs or cultures from today's evaluation,your results should take up to 2-7 days.You will be
notified of POSITIVE or ABNORMAL results only.You are welcome to call us in 7 days to check on your results if you
do not hear from us.Our phone number is 425-688-5777.
If there are any pending labs or cultures from today's evaluation,your results should take up to 2-7 days.You will be
notified of POSITIVE or ABNORMAL results only.You are welcome to call us in 7 days to check on your results if you
do not hear from us.Our phone number is 425-688-5777.
MyChart
MyChart allows you to send messages to your Overlake Outpatient Clinic Doctor,view your test results,view your
medical record, and more.To sign up, log on to https://mychart.overlakehospital.org/mychart/Once you are logged
on, click on the Sign Up Now link and you will access the new member signup page. Enter your MyChart Access
Code exactly as it appears below then complete the sign-up process. If you do not sign up before the expiration
date,you must request a new code.
MyChart Access Code:9NQ5Q-5HVZN-TGGD2
Expires:7/30/2019 5:53 PM
If you have questions,you can call 844-750-8525 or email mychartsupportPoverlakehospital.org. Remember,
MyChart is NOT to be used for urgent needs. For medical emergencies,dial 911.
Gary J.Williamson (10/17/1944) • Printed at 6/30/19 5:53 PM Page 2 of 4 WC
Your Medication List as of 6/30/19 5:53 PM
If you have any questions about this medication list, please send a message to your doctor via your ONE Chart
account or call your doctor's office.
acetaminophen 325 mg tablet Take 325 mg by mouth as needed. Do not exceed
Commonly known as:TYLENOL 4000 mg of acetaminophen/24 hours. If 65 or older,
do not exceed 3000 mg of acetaminophen/24 hours.
albuterol 90 mcg/Actuation inhaler Inhale 1-2 puffs into the lungs every 6 (six) hours as
Commonly known as: PROVENTIL HFA/VENTOLIN HFA/PROAIR needed for Wheezing
HFA
Started by: Karin Pedersen, PA
aspirin 81 MG EC tablet Take 81 mg by mouth daily.
atorvastatin 40 MG tablet TAKE 1 TABLET(40 MG) BY MOUTH DAILY
Commonly known as: LIPITOR
azithromycin 250 MG tablet Take 2 (two)tablets (500 mg) by mouth on the first
Commonly known as:ZITHROMAX day,then 1 (one)tablet(250 mg)once daily for four
Started by: Karin Pedersen, PA days.
benzonatate 200 MG capsule Take 1 capsule (200 mg total) by mouth 3 (three)
Commonly known as:TESSALON times daily as needed for Cough
Started by: Karin Pedersen, PA
cefuroxime 500 MG tablet Take 1 tablet(500 mg total) by mouth 2(two)times
Commonly known as:CEFTIN daily
Started by: Karin Pedersen, PA
furosemide 40 MG tablet Take 1 tablet(40 mg total) by mouth daily
Commonly known as: LASIX
inhalational spacing device Sper Use with inhaler
Started by: Karin Pedersen, PA
lisinopril 10 MG tablet Take 1 tablet(10 mg total) by mouth daily
Commonly known as: PRINIVIL,ZESTRIL
* metoprolol tartrate 50 MG tablet TAKE 1 TABLET(50 MG) BY MOUTH TWICE DAILY
Commonly known as: LOPRESSOR
* metoprolol tartrate 50 MG tablet TAKE 1 TABLET(50 MG) BY MOUTH TWICE DAILY
Commonly known as: LOPRESSOR
MULTI VITAMIN ORAL Take by mouth.
pantoprazole 40 MG tablet Take 1 tablet(40 mg total) by mouth daily
Commonly known as: PROTONIX
potassium chloride SA 20 MEQ tablet Take 1 tablet(20 mEq total) by mouth daily
Commonly known as: K-DUR,KLOR-CON
VITAMIN D3 2,000 unit Cap Take by mouth.
Generic drug:cholecalciferol (vitamin D3)
*This list has 2 medication(s) that are the same as other medications prescribed for you. Read the directions
carefully, and ask your doctor or other care provider to review them with you.
Overlake Urgent Care considers it a privilege to provide your medical care today. To gauge our performance and how
well we have met your health needs,we may send you a Press Ganey survey via email or US mail. It is our mission to
Gary J.Williamson (10/17/1944) • Printed at 6/30/19 5:53 PM Page 3 of 4 EPIC
•
provide medical excellence every day and personal care that is worthy of your recommendation and praise. If we have
not met your expectations, please let your care team know before your discharge to allow us to address it and correct it
before you leave today. Thank you.
Gary J.Williamson (10/17/1944) • Printed at 6/30/19 5:53 PM Page 4 of 4 EEC
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