2006, 03-20 MH Title Elimination ApplicationRETURN ADDRESS
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L4C� i 'D C . u %SN7IYCTOJ MANUFACTURED HOME
APPLICATION
PLEASE CHECK ONE
- -�ITLE ELIMINATION ❑ TRANSFER IN LOCATION . , EMOVAL FROM REAL PROPERTY
o MANUFACTURED HOME
T.Pj.O /PLAT 8E YEAFA y.
a LAND
ILENGTH/WIDTH(FEE
I' 1
T) VEHICLE IDE T FICAT NUMBER (VIN)
SIX :.n 140 ' -_/
ADDITIONAL LEGAL DESCRI TION ON PAGE
MANUFACTURED HOME WILL BE FFIXED ❑ REMOVED
PROPF1TL' j Pr1{�CEL UMAR /7 k I
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P T AME
A legal descriptinn can be obtained from the local County Assessor's Office. If there is not enough room here,
use the Application Attachment form, TD- 420 -732, available at your local County Auditor's Office.
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LOT r'7 BLOCK
SECTION/TOWNSHIP /RANGE
GRANTOR(S) REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE
COUNTY it INCORPORATED UNINCORPORATED # REGISTERED OWNERS # LEGAL OWNERS
NAME-6F,FIRSI RESIST
TITLE FEES
FILING FEE
APPLICATION
MOBILE HOME FEE
ELIMINATION FEE
USE TAX
SUB -AGENT FEES
TOTAL FEES & TAX
ERED d�JNER -
/K` �� rLG�YA_v ��W i � ` I 1 DOL Cr/U�SjT'OMER ACCOUNT NUMBER
ADDRESS OF.FIRST FIE�GIS�TEREq O )WNEEI) Alit ' C ^! CITY W J ('� r ��•
l I lL�:'1/ L/fl C /7L/�.�t' / Wt . i�,7 4�1K (,. " l "i 1i. C( ,1 ZIP CODE
NAM�,OF; FIRST L A OWNER f icryhm L.
ADDRES RO ST l L E A L ✓ O WNG it ` i � n y l A91 CI
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ZCODE
GRANTEE(S
I
t , 1))) STATE
UJl 3
DOL CUSTOMER ACCOUNT NUMBER
TD- 420 -729 MANUF HOME APPL (R/12/96)OR Page 1 of 2
INSTRUCTIONS AND ADDITIONAL INFORMATION ON REVERSE SIDE
rauuri ILJNAL NAMES ON PAGE •
NAME OF FIRST GRANTEE
DOL CUSTOMER ACCOUNT NUMBER
Anyone who knowingly
makes a false statement of a material
fact is guilty of a felony, and upon conviction may be
punished by a fine, imprisonment, or both. (RCW 46.12.210)
I DO SOLEMNLY ATTEST UNDER PENALTY OF PURJURY
LAW THAT I / WE ARE THE REGISTERED OWNERS OF
THIS VEHI LE AND THIS
INFORMATION IS ACCURATE:
SIGNATURE OF LEGAL OWNER INDICATES CONSENT FOR �
ELIMINAT ON OF TITLE / REMOVAL FROM REAL PROPERTY X ' I 6,...,1e____---,
SSIGN TORE OF FIRST 'EGIST. gED OWNER AND TITLE, IF APPLICABLE
SIGNATURE OF FIRST LEGAL OWNER AND TITLE, IF APPLICABLE
SIG ATURE OF E 1 D R STERED OWNER AND TITLE, IF APPLICABLE
NOTARY f{y 01111' 1 MR, NOTARIZATION
/ CERTIFICATION FOR REGISTERED OWNER(S)
�\\�,�\ ,i\,1 ,i •/v ",,,, .
�°� J ......... ra "4 n'•• '�• State of Washington
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� ��T' "'I h.: Signed or attested
t' ' ^ County ofV���'\!J before
`r
SIGNATURE
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^ me on
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- "°`t p• ..yam 1��ry V LVU/' Jr" %7
« Signature -
-� �.._._..
-.. j: • , e • 3� rr == VD rioted Name of Applicant
•• Title U Dealer No. OR
` c AND: County/Office `I
".,...
( I
7
,,fe c(; No. OR
�i ' � •,' •. �� : I'` ALERSHI, P sition /A ent/NOTARY
i,.''1 a, •....• 9 Notary Expiration Date
1/11/11,11111110 I
DEALER'S
REPORT OF SALE I certify that this information is correct. The vehicle is clear of encumbrances except as shown.
DEALER
NAME
WA DEALER NUMBER
DATE OF SALE
PURCHASE.
PRICE I TAX JURISDICTION /TAX RATE I DEALER'S AUTHORIZED SIGNATURE
E USE TAX EXEMPT Sale to a Certified Tribal member on the reservation (attach notarized statement of delivery).
i�
COUNTY AUDITOR /AGENT LICENSING OFFICE APPROVAL: (Not for use by Sub - Agents)
proceed
certify that the above application appears to have been completed correctly, and the applicant has sufficient documentation to
with the recording of this form.
NAME
(TYPED OR PRINTED)
COUNTY OFFICENFS OPERATOR NUMBER
SIGNATURE
DATE
TD- 420 -729 MANUF HOME APPL (R/12/96)OR Page 1 of 2
INSTRUCTIONS AND ADDITIONAL INFORMATION ON REVERSE SIDE
U TITLE COMPANY CERTIFICATION
h legal description of the land and ownership is true and correct per the real property records.
SIGMA U /POSITION �� 7y ���� L�(y. 404
1/4P-if
Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs.
1: Finalize
PERMIT OFFICE CERTIFICATION
I certify that the manufactured home has been affixed to the real property as described, OR a building permit has,bepn i s� or thi
1 certlfy� at the
egg eS LE C PANY /P. BER
NAME D /// of (, �/ �/ i7 Y�.-�/ l ( Ct7 i " -F'.
purpose and the attachment will be inspected upon completion
NAME-
WI t
SIGNAT RE / POSITION ) S
BLDG PERMIT OFFICE /PHONE a
DATE
INSTRUCTIONS
COMPLETE DEPENDING APPROPRIATE
TRANSACOTION THE FORM YOU WISH AS
TO PROCEDS BELOW,
G
A. Manufactured Home Title Elimination Application (complete boxes 1, 2, 3, 4 and 6). Use to eliminate a title for a manufactured
home which is to become real property.
B. Manufactured Home Transfer In Location Application (complete all boxes). Use only when a manufactured home (whose
title has been eliminated) is being moved to land with a different legal description AND will become part of the real property to
which it will be moved and affixed. If the transfer in location is between two different counties, prepare this form in duplicate and
have each recorded in its respective county.
C. Manufactured Home Removal From Real Property Application (complete boxes 1, 2, 3, 4 and 5). Use when titling a
manufactured home whose title has been previously eliminated. Once properly completed and recorded, this application
becomes a supporting document along with others required to apply for a Certificate of Title for the manufactured home.
IMPORTANT: SIGNATURES OF THE OWNERS ON THE MANUFACTURED HOME APPLICATION INDICATE TERMINATION
OF INTEREST IN THE MANUFACTURED HOME THROUGH TITLE PROVIDED BY CHAPTER 46.12 RCW AND INDICATE
INTENT TO PERFECT INTEREST IN THE MANUFACTURED HOME AS REAL PROPERTY WITH THE LAND HE /SHE/THEY
OWN AND TO WHICH IT IS/WILL BE AFFIXED. IF THE MANUFACTURED HOME IS BEING REMOVED FROM REAL
PROPERTY, SIGNATURES OF THE OWNERS PER THE REAL PROPERTY RECORDS INDICATE CONSENT TO THE
REMOVAL. THE FORM MAY THEN BE USED FOR MAKING APPLICATION FOR TITLE WITH THE DEPARTMENT OF
LICENSING AS PROVIDED BY CHAPTER 46.12 RCW.
Note: Owners of the manufactured home must own the land when the application is for a Manufactured Home Title
Elimination or a Manufactured Home Transfer In Location, as provided by Chapter 65.20 RCW.
SECTION 1 Enter the description of the manufactured home.
SECTION 2 Place an "X" in the appropriate box and enter the property tax parcel number, lot, block, plat number and
section /township /range, when applicable. Write a legal description in the space provided. If there is not enough room,
use the Title Application Attachment (TD0420 -732). When processing a "Transfer in Location Application," both boxes
should be checked. The application must then be accompanied by two separate land descriptions.
SECTION 3 This area must be signed by all registered owners of the manufactured home when processing a title elimination. If
the manufactured home has been sold and is being removed from the real property, the owners per the real
property records must complete this portion to obtain a Certificate of Title. Signatures of the owners must be
notarized or certified by the selling dealer or a vehicle licensing agent. Fees will include a filing and application
fee plus sales i ill charge tax due. an additional dtlse service fee. include: a title
elimination fee
change withouut notice.)
Home Affairs Fee.
Subagent charge
4 Take the properly completed Manufactured Home Application and all necessary supporting documents to the County
Auditor /Licensing Agent Office for approval. Supporting documents may include but are not limited to: proof of
ownership or a Manufacturer's Statement of Origin (MSO), proof of taxes paid, and applicable release(s) of interest.
Subagents may not complete the approval portion of this form.
SECTION 5 From Re Company Certification" pplication. Important: ortant: The completed l ecofrded application torrm must be submitted to a "Removal
From Real Property" app P
licensing agent within 10 days of the title company's certification.
SECTION 6 When processing manufactured home) must cerrttify that the home iscaff affixed to he land;or,iss (depending
issue abuiillding permit to affix
location of f the
the manufactured home to the land, inspecting the completed attachment. The issuing office must sign the
application, adding the permit number if the inspection has not yet occurred.
IMPORTANT: Once the application has been approved by the County Auditor /Licensing Agent Office, take your application
form to the County Recording Office. Retain proof of the recording fees paid. If the Recording Office retains
your original application form, obtain a certified copy of the recorded form.
APPLICANTS: Once recorded, you must return to a Vehicle Licensing office to file the Manufactured Home Application,
paying all required fees.
The Department of Licensing has a policy of providing equal access to its services.
If you need special accommodation, please call (360) 902 -3600 or TDD (360) 664 -8885.
TD- 420.729 MANUF HOME APPL (R/12/96)OR Page 1 0l 2