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2005, 12-28 MH Title Elimination( RETURN ADDRESS Spokane County Title 11703 E. Sprague Ave #B2 Spokane, WA 99206 V3580 L4 srArETrwAsn:NrroN MANUFACTURED HOME kEnsinc APPLICATION I�t�/ PLEASE CHECK ONE aITLE ELIMINATION •TRANSFER IN LOCATION Anyone who knowingly makes a false statement oiamaterial fact Isgullty of a felony, and upon conviction may be punished by a fine, Imprisonment, or both. • REMOVAL FROM REAL PROPERTY (RCW 46.12.210) 0 MANUFACTURED HOME TPO / P TE NUMBER YEAR 1969 MAKE Marlette LENGTH/WIDTH(FEET) 55 X 20 VEHICLE IDENTIFICATION NUMBER (VIN) 591312A Bs014U LAND LEGAL DESCRIPTION ON PAGE MANUFACTURED HOME WILL BE ® AFFIXED • REMOVED R PRD192PERTY TAx PARCEL NUMBER 5. t.) LOT �'�I BLOCK PLAT N ME ��it ilee1 �1 sfS SECTION/TOWNSHIP/RANGE © GRANTOR(S) REGISTERED/LEGAL OWN (S) ADDITIONAL NAMES ON PAGE COUNTY NUMBER NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS NAME OF REGISTERED OWNER Sandra E. Simmonds NAME OF ADDITIONAL REGISTERED OWNER Kenneth A. Risley ADDRESS/1CITY STATE ZIP CODE -34ee 224- 4i-(Abo,J 0202— I-aA.€1 s rx � NAME OF LEGAL OWNER Same as Registered Owner NAME OF ADDITIONAL LEGAL OWNER ADDRESS CITY STATE ZIP CODE 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: i • 0I. Signature of Registered Owner and Title, IF APPLICABLE _e G c _- r, ,c a-6 Sign54ureofAdditional Registered Owner and Title, IFAPPLICABLE . _, s� . . ., NOT^RV'SEAUGRSiY P 'I NOTARIZATION/CER CA ON FOR REGISTERED OWNER(S) SI r ATURE :' dA ;`�:!`,..emu tb4o ll�, State of Washington ( r .,, Signed •r attested mead .��� -< •"l" -'v"''= A • Count of C I y, �� be ore me on LIE' gr, -,.i_ti5 /yby �[ .r (Ler �m11���vi�,S •Signature / 4� r: y"D` - • ✓ P1INTNAMEOFREGISTEREDOOWNER Vii: ;y, '' ^ t~`' ' ISS b'y' IIsil eA n f-1 S I r L NO ; rA•E11/ �_ !�'9, ,- J, i. ("'(_;;",,a> ' .4 -• I �' 'PRINT NAME OF REGI$TERE !'a... +,:.. (0. ,:#47,73' s t \^�, �/ l�� OWN R y PRINT D NAME OF NOTARY t,�� County/Office No. OR I(.+ 'r•1t 1�`A'j4�f: `` �4RIe 1 �Il 'I l��r ', "`� AND: Dealer No. OR �,( , * ' (' •.. , ,,, , ,,, ,;~ ',,I(' DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Date arITLECQMPANY;cnitfFICATION I certify thattItttte jar description of the land and ownership Is true and correct per the real property records. NAME (TYPED OR PRINTED) TITLE COMPANY / PHONE NUMBER SIGNATURE / POSITION DATE Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs. © BUILDING PERMIT OFFICE CERTIFICATION I certify that: O the manufactured home has been affixed to the real property as described. 0 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 1, BLDG PERMITI1 SIGNATU E rIOONN (� i DATy,, —\� TOaeO 2 f MANbF HOME AP/L (Rle/9e)OR Page , of 2 11 D SIGNATURE OF LEGAL OWNER SIGNATURE OF LEGAL OWNER INDICATES CONSENT FOR IMINATION OF TITL / REMOVAL FROM REAL PROPERTY. Signature of Legal Owner and Title, IF APPLICABLE 1ALP�-Pte+-vim,-,-_-PS-L-1. P Signature of AdditionalLegalOwner and Title, IFAPPLICABL. ,C% NOTARyiq,kL..OAt91,, +; R^{'f',.i,/, NOTARI 0 CERTIFICATION FOR LEGALOWNER(S) GNATURE ' ,.3'p t(,. I.'k('I.I I 1. 1/j / :IYeof Washington of Q� ' -� Sign b ore mst-. ati� 1�� ,�, . .w Y' I•,• (may p`a yC*C� / ^, fiti ....._ �i !'° 4At k ik C i M YY1L- &v)S Signature 1 ' )� , Pw� I .a PR NAME OF LEGAL OWNS N• ARY OR ENT i" 3 ' A e"to .+.`;' ` e3Y `�LIi YAC i^ —(L 1,r---`- `L Y/-1 1 1 KL% - �l/ s':2..-42,, 0 f -0.4, rC,_-, : VpRINT NAME OF LEGAL OW ER PRINTED NAME OF NOTARY iJJr\,1/2 iltto`".���<, I \t� -�.� ,(� y/j� County/Office No. OR 1 (-CI tittitiari(4?? � fiitle 1 ., t\iii,V1 VO &AG-- AND: Dealer No. OR '`-1 01-'' t'' I'........,<�.�� ;! t.' DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Date Dy/AND DESCRIPTION-(A legal description of the lana can be obtained from the local County Assessor's Office Lot 24, Block 2, APPLE VALLEY ESTATES, as per plat recorded in Volume 9 of Plats, page 26, records of Spokane County; 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 OF ENCUMBRANCES EXCEPT AS SHOWN. ANY REOUIRED SALES TAX HAS BEEN COLLECTED. DEALER NAME (TYPED OR PRINTED) WA DEALER NUMBER GATE OF SALE PURCHASE PRICE TAX JURISDICTION/TAX RATE DEALER'S AUTHORIZED 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 certifythatthe above application appears to havebeen completedcorrectly, and the applicant has sufflcientdocumentationto proceed with the recording of this torr. NAME (TYPED OR PRINTED) COUNTY OFFICENFS OPERATOR NUMBER SIGNATURE DATE rn TITLE FEES FILING FEE APPLICATION MOBILE HOME FEE ELIMINATION FEE USE TAX SUBAGENT FEES TOTAL FEES & TAX 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. 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 feee. 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 alLlcensing has a policy of providing equal access to its services. If youneedspecial accommodation, please cal (360) 902-3600 or TDD (360) 664-8885. TD•12D729 MANUF HOME APPL (W1/98)OR Pape 2 of 2