1995, 08-08 Title EliminationLIAT" '^iworniNGT0, MANUFACTURED HOME
ICEfSIfG . APPLICATION
RECORDER'S CLt. .
FILED AT THE REQUEST OF:
NAME
ADDRESS
Please
check one -
TITLE ELIMINATION (Complete all but section 3, below)
TRANSFER IN LOCATION (Complete ALL sections below)
REMOVAL FROM REAL PROPERTY (Complete all but section 4, below)
7011 MANUFACTURED HOME
TPOIPLATE NUMBER
216241 TPO
YEAR
72
MAKE
Flami
WIDTHILENGTH
65x14
VEHICLE IDENTIFICATION NUMBER (VIN)
1823
LAND
• Attach a copy of the legal description of land. It can be obtained from Coun
your your y
Assessor's office or it may be typed or printed on an Additional Attachment Form (TD -420-732):
Manufactured home will be x AFFIXED REMOVED
PROPERTY TAX PARCEL NUMBER
55182.1518
I I
; TITLE COMPANY CERTIFICATION
I certify that the legal description of the land and ownership is true and correct per the real property records.
NAME
•X
TITLE COMPANY/PHONE NUMBER
SIGNATURE
DATE
Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs.
I BUILDING PERMIT OFFICE CERTIFICATION
I certify that the manufactured home has been affixed to the real property as described, or abuilding
permit has been issued for this purpose and the attachment will be inspected upon completion.
BLDG PERMITtl
L. 3 (C36'
NAAE f� � t` �I n Z
&i 1 ,' I f
SIGNATURE/TITLE SPOKANE COUNTY
X DIVISION OF BUILDING AND PLANNING
BLDG PERMIT OFFlCEIPHONED
!
�1 rig 31, 7 — y
DATE
L2 , �� _y� .
ei OWNER INFORMATION
FEES
COUNTY INC UNINC
❑ ❑
* REGISTERED OWNERS
# LEGAL OWNERS
Provide the Washington Driver's License or I.D.
card number (PIC) tor each owner:
FILING FEE
kE'
NAME OF FIRST OWNER
Francis X Binder
6/,/ b&rxi-{8(K`J
APPLICATION
A0
NAME OF SECOND OWNER
MOBILE HOME FEES
:)•E
R.
ADDRESS OF OWNER
17721 E. Boone Ave
--OR-- it the owner is a business,
ELIMINATION
' O•{
CITY
Spokane
STATE
Wa
ZIP CODE _
99016
provide the Unified Business
Identifier (UBI), found on the
business Registration Licenses
USE TAX
1
I',
NAME OF FIRST LEGAL OWNER'
Same
•&
Document.
SUB -AGENT FEES
e
N;
14
MAILING ADDRESS OF FIRST LEGAL OWNER
More than two owners or one
lienholder? Please use attachment
TOTAL FEES & TAX
'•t.1
CITY
STATE
ZIP CODE
form(s) #TD -420-732.
$ I
'1N.
DEALER'S REPORT OF SALE
+.^'
•SIGNATURE OF LEGAL OWNERINDI[ATESCONSENT FOR ELIMM ION OFT LE/REMOVAL
FROM REAL PROPERTY: x //je"140, X- OJ/ C6
I certify that this information is correct. The vehicle is clear
of encumbrances except as shown.
Anyone who knowingly makes a false statement of a material fact is guilty of a felony, and
upon conviction may ha punished by a line of up to $5,000 and/or 10 years imprisonment
DO
WA DLR NO.
DATE OF SALE
PURCHASE PRICE
$ -
(RCW 46.12.210). I SOLEMNLY ATTEST UNDER PENALTY OF PERJURY LAW
THAT I/WE ARE THEREGISTEREDOWNERS OF THIS VEHICLE AND THIS INFORMA-
TION IS Ayf URATE: 0lyner Signature ) b Title/(el:
DEALER NAME
TAX JURISDICTION/TAX RATE
// " ./i;/
DEALER'S AUTHORIZED SIGNATURE
X
X
USE TAX EXEMPT Sale to a Certified Tribal member on
the reservation (attach notarized statement of delivery)
NOTA
OR
OR LICENS BENT BfllJMB/E�,,
� .. - I/ Nr[,
uR
SSuCRIBED TO AND SWORN BEFORE ME THIS
V r DAY OF A t) 19 ISlS
Residing in (County)
S PoKA nI E -
COUNTY AUDITOR/AGENT LICENSING OFFICE APPROVAL: (Not for use by Sub -Agents)
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
SIGNATURE
X
OFFICENFS OPERATOR NUMBER
DATE
420 ]29 MANUF HOME APPL (R2/94)M Page 1 of 2