Washington Code § 46.17.110

Emergency medical services fee
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(1) Before accepting an application for a certificate of title for a motor vehicle as required in this title, the department, county auditor or other agent, or subagent appointed by the director shall require the applicant to pay a six dollar and fifty cent emergency medical services fee for the following transactions: (a) All retail sales or leases of any new or used motor vehicles; and (b) Original and transfer certificate of title transactions. (2) The emergency medical services fee: (a) Is not considered a violation of RCW 46.70.180(2); (b) Does not apply to motor vehicles declared a total loss by an insurer or self-insurer unless an application for certificate of title is made to the department, county auditor or other agent, or subagent appointed by the director after the declaration of total loss; and (c) Must be distributed under RCW 46.68.440.

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