2009, 06-12 MH Title Elimination ApplicationAFTER RECORDING MAIL TO:
First American Title Company
12209 E. Mission #3
Spokane Valley, WA 99206
to lo z Aic;
Filed for Record at Request of:
First American Title Insurance Company
Space above this line for Recorders use only
MANUFACTURED HOME
PLEASE CHECK ONE
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APPLICATION
IkEnShIG
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.
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I
TITLE ELIMINATION
TRANSFER IN LOCATION
1 REMOVAL FROM REAL PROPERTY
(RCW 46.12.210)
1 MANUFACTURED HOME
TPO /PLATE NUMBER
YEAR
2009
MAKE
Karsten
LENGTH /WIDTH (FEET)
48 X 27
VEHICLE IDENTIFICATION NUMBER (VIN)
STA 029444Q/{
2 LAND LEGAL DESCRIPTION ON PAGE 2
MANUFACTURED HOME WILL BE X
AFFIXED
REMOVED
REAL PROPERTY TAX PARCEL NUMBER
45143.0236
LOT
9
BLOCK
1
PLAT NAME OR SECTION/TOWNSHIP /RANGE
Veradale Hieghts 1st Addition //
OUARTER/OUARTER SECTION
3 GRANTOR(S) REGISTERED /LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE
COUNTY NUMBER
0144
NUMBER OF REGISTERED OWNERS
2
NUMBER OF LEGAL OWNERS
0
NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
Ronald L. Thompson
NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
Catherine B. Thompson
ADDRESS CITY STATE ZIP CODE
PO Box 964, Veradale, WA 99037
NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
ADDRESS CITY STATE ZIP CODE
GRANTEE
NAME
N/A
I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT I /WE AM /ARE THE REGISTERED OWNER(S) OF
THIS VEHICLE AND THIS INFORMATION IS ACCURATE: t __ /
Signature of Registered Owner and Title, IF APPLICABLE -'' �� '0 �
AIIIN
Signature of Additional Registered Owner and Title, IF APPLICABLE i[7%� /f . ;i:: , i/�
�```� 1iAnt ��A1, ; STAMP i NOTARIZATION /CERTIFICATION FOR REGISTERED OWN ' (S) SIGNATURE
0 1 1 State of Washington Signed or attested
GOE q I 23.09
H•r /� County of Spokane before me on 1 4/,
#' ...0N F,'A,1� //� I by Ronald L. Thompson Signature (- -- /C/ / i-(- -c
. OTA tt e r„ / PRINT NAME OF REGISTERED OWNER N )CRY 0R G -. "
to $ � , by Catherine B. Thompson i' 1 � - � ��E l )
�
- � -
Z i PRINT NAME OF REGISTERED OWNER ' PRINTED NAME OF NOTARY
�° County/Office No. OR
"V
V1� �/ A"V
Notarj/ AND Dealer No. OR
S49
/ NI 49 I Title .___._._...-___._
�1-�0 S� I -DEALERSHIP POSITION /AGENT /NOTA• Notary Expiration Date ()
.,ft ) 1
Q-- -J •, '' CeR1 FICATION . a / T G.,/= G c::V- '/4c%,
,,
lice fy ttidt kTe Legal d cription of the land and ownership is true and co rect per the real property records.
NAME " PRINTED) Jc zJ /1.14-62/10/4,4/2-c TITLE COMPANY /PHONE NUMBER
'�(T , First A erican Title Insurance ompany (509)1456 -0550
SIGNATURE /POSITION 7- - -- w .- E DATE i.
Finalize this application with a Licen alendar days of the date Title Company Representative signs.
BUILDING PERMIT OFFICE CERTIFICATION
I I the manufactured home has been affixed to the real property as described.
I certify that:
a building permit has been issued for this purpose and the attachment will be inspected upon completion.
N ME (TYPED OR pRINTED) BLDG PERMIT OFFICE /PHONE #
\ `A ‘ rftu \ `� )9 " ft )
BLDG PERMIT #
,S; ck, t4 5
SIGNA RE / POSITION fl DATE C�
T.(f,� -i) d`L 4L L,C, -,1- �� j' 2_1 Ll. �. %- �(5°.lti�K� �. --` - --'-'- ��1 �, ^� ��
'` c n1 cv_1 Ah1Ee fnc■
TD- 420-29 MANUF HOM 'APPL (R/2 /02)OR (W)P o
MANUFACTURED HOME — FROM SECTION 1
TPO /PLATE NUMBER
YEAR
2009
MAKE
Karsten
LENGTH /WIDTH (FEET)
48 X 27
VEHICLE IDENTIFICATION NUMBER (VIN)
STA 0294440/2.
6 SIGNATURE OF LEGAL OWNER
SIGNATURE OF LEGAL OWNER INDICATES CONSENT FOR ELIMINATION
Signature of Legal Owner and Title, IF APPLICABLE
Signature of Additional Legal Owner and Title, IF APPLICABLE
OF TITLE /REMOVAL FROM REAL PROPERTY.
NOTARY SEAL OR STAMP I
I
State of Washington
by
NOTARIZATION /CERTIFICATION FOR LEGAL OWNER(S) SIGNATURE
Signed or attested
County of Spokane before me on
Signatur
e
PRINT NAME OF LEGAL OWNER NOTARY OR AGENT
by
PRINT NAME OF LEGAL OWNER PRINTED
Title Notary AND
NAME OF NOTARY
County/Office No. OR
Dealer No. OR
Notary Expiration Date
DEALERSHIP POSITION /AGENT /NOTARY
7 LAND DESCRIPTION (A legal description of the land can be obtained from the local County Assessor's Office)
LOT 9, BLOCK 1, VERADALE HEIGHTS 1ST ADDITION, AS PER PLAT RECORDED IN VOLUME 2 OF PLATS, PAGE 42, RECORDS
OF SPOKANE COUNTY; CITY OF SPOKANE VALLEY.
SITUATE IN THE COUNTY OF SPOKANE, STATE OF WASHINGTON.
8 DEALER'S REPORT OF SALE
I CERTIFY THAT THIS INFORMATION IS CORRECT. THE VEHICLE IS CLEAR 0 ENCUMBRANCES EXCEPT AS SHOWN. ANY
REQUIRED SALES TAX HAS BEEN COLLECTED.
DEALER NAME (TYPED OR PRINTED)
NC1iS i LlC-
WA DEALER NUMBER
07“5 -4.3>' 6s2-
DATE OF SALE
/31.-/S
PURCHASE PRICE
TAX JURISDICTION/TAX RATE 41:4117/ fhjj/
Cf /LCV1.1ii:% - Rol
DEAD R'S AUT RIZED SIGNATURE
( �
USE TAX EXEMPT Sale to a Certified Tribal member on the reservation (attach notarized statement of delivery)
9 COUNTY AUDITOR /AGENT LICENSING OFFICE APPROVAL: (Not for use by Subagents)
I certify that the above application appears to have been completed correctly, and the applicant has sufficient documentation to
proceed with the recording of this form.
NAME (TYPED OR PRINTED)
COUNTY OFFICE /VFS OPERATOR NUMBER
SIGNATURE
DATE
10 TITLE FEES
FILING FEE
APPLICATION
MOBILE HOME FEE
ELIMINATION FEE
USE TAX
SUBAGENT FEES
IMPORTANT:
Once the application has been approved by the County Auditor /Vehicle Licensing
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.
TOTAL FEES & TAX
APPLICANTS: Once recorded, you must return to a Vehicle Licensing Office to file the
Manufactured Home Application, paying all required fees. Vehicle licensing
subagents charge a service fee.
For full instructions on completing this form for title Elimination, Removal from Real Property or
Transfer in Location, see form TD- 420 -730, Manufactured Home Application Instructions.
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/2/02)OR (W) Page of