2010, 09-09 MH Title EliminationRETURN ADDRESS
Vanderbilt Mortgage and Finance, Inc.
P.O. Box 4007
Maryville, TN 37802
C•�WASHINGTON STATE DEPARTMENT OF Manufactured Home j-ITLE ELIMINATION
LICENSING Application (�■TRANSFER IN LOCATION
II REMOVAL FROM REAL PROPERTY
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)
u MANUFACTURED HOME
TPO / PLATE NUMBER
YEAR
4 1
MAKE
0 4 4 — 4
LENGTH/WIDTH(FEET)
5 2-X 2 1 -
VEHICLE IDENTIFICATION NUMBER (VIN)
A 1-8 o.3 4- Lt 0P_.
LEGAL DESCRIPTION ON PAGE
® LAND
MANUFACTURED HOME WILL BE [AFFIXED II REMOVED
REAL PROPEgIY TAX PARCEL NUMBER
_1 S i 55 2 , 54.0-7
LOT
BLOCK
PLAT NAME OR SECTION/TOWNSHIP /RANGE
QUARTER /QUARTER SECTION
ADDITIONAL NAMES ON PAGE
3
COUNTY
GRANTOR(S) REGISTERED /LEGAL OWNER(S)
NUMBER
NUMBER OF REGISTERED OWNERS
0
NUMBER OF LEGAL OWNERS
1
NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
Steve Hills
NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
ADDRESS CITY STATE ZIP CODE
1210 N. Arc Street Spokane Valley WA 99016
NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
Vanderbilt Mortgage and Finance, Inc.
NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
ADDRESS CITY STATE ZIP CODE
P.O. Box 4007 Maryville TN 37802
GRANTEE
NAME
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: ��
APPLICABLE
Signature of Registered Owner and Title, IF
IF APPLICABLE
Signature of Additional Registered Owner and Title,
NOTARY SEAL OR STAMP I NOTARIZATION /CERTIFICATION FOR REGISTERED OWNER(S) SIGNATURE
Mate of Washington Signed or attested �) 1 2 I
before me on
cA
JESSICA R. MALSTROMI County of - 9u�iL IAA_
i�pJ� , n
NOTARY PUBLIC',, S -tV -� t- `-ill S Signature ��t'�i1i1`— °1�11� .
NARY
STATE OF WASHINGTON y PRINT NAME OF REGISTERED OWNER OR AGENT
COMMISSION EXPIRES 1 --JS - K. IA pdG Y-Ir+A.
NOVEMBER 9, 2011 y PRINT NAME OF REGISTERED OWNER PRINTED NAME OF NOTARY
- T I ~ County /Office No. OR Y I�� �Dj'
AND: Dealer No. OR 1 UU
i Title I V t " °
DEALERSHIP POSITION /A NT /NOTARY Notary Expiration Date
4
I certify
TITLE COMPANY CERTIFICATION
that the legal description of the land and ownership is true and correct per the real property records.
NAME (TYPED OR PRINTED) TITLE COMPANY / PHONE NUMBER
Pam/Jessica Spokane County Title Company 5093434343
DATE
S 'NATURE /PO$ I N
c rib Lur
alize this a lication with a Licensing Agent within 1 s calendar days of the date Title Com any epresenfative signs.
p
5 BUILDING PERMIT OFFICE CERTIFICATION
I certify that: ja the manufactured home has been affixed to the real property as described.
I a building permit has been issued for this purpose and the attachment will be inspected upon completion.
NAME (TYPED OR PRINTED) BLDG PERMIT OFFICE /PHONE N
s;,, ---zz®- SZya
BLDG PERMIT 5
090:1M—Py
no.
SIGNATURE /POSITI _ / — °`r,kr,/Y∎∎A- \YY!r\ V •!)'1 1 Tc`,)
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TRADE NAME
OAKWOOD
CERTIFICATE OF ORIGIN
MANUFACTURED HOME
CMH MANUFACTURING WEST, INC.
IDENTIFICATION NUMBER
ALB032944OR - AB
MODEL
72FSH28523AH09
DATE OF
YEAR TITLE TRANSFER
2009 5/08/
WIDTH LENGTH LENGTH WEIGHT INVOICE
324" 56 52 36400 32944 - A
(INHITCH) G (EXCLUDING
HITCH)
The undersigned certifies that: The home is the property of the manufacturer; this is the first
transfer; and ownership (subject to payment being received) is properly transferred to the following:
DEALER:
MANUFACTURER:
No. 3779
L
P
L
CMH HOMES, INC.
DBA: CLAYTON HOMES - VERADALE
15906 E. SPRAGUE AVE
VERADALE, WA 99037
CMH MANUFACTURING WEST, INC.
Albany
2445 PACIFIC BLVD , SW
ALBANY, OR 97321
BY:
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MFG 1056