Form of certificate

Whenever the governor shall determine to restore his or her civil rights to any person convicted of an infamous crime in any superior court of this state, he or she shall execute and file in the office of the secretary of state an instrument in writing in substantially the following form:"To the People of the State of WashingtonGreeting:I, the undersigned Governor of the State of Washington, by virtue of the power vested in my office by the constitution and laws of the State of Washington, do by these presents restore to . . . . . . . . . his or her civil rights forfeited by him (or her) by reason of his (or her) conviction of the crime of . . . . . . . . . (naming it) in the Superior Court for the County of . . . . . . . . ., on to-wit: The . . . . day of . . . . . ., (year) . . . .Dated the . . . . day of . . . . . ., (year) . . . .(Signed) . . . . . . . . . . . . . . . . . . . . . . .Governor of Washington."