1995, 03-31 Dept of Licensing MH ApplicationSTATE OF WASHINGTON
Deportment of
lcEns/nG MANUFACTURED HOME APPLICATION
TITLE OPTIONS
Original
Transfer
Duplicate
Reissue
❑ 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)
RECORDER'S CLOCK
RECORDED AT
REQUEST OF:
MANUFACTURED HOME
YEAR
1978
MAKE"': .
KENTWOOD
WIDTH/LENGTH ...
VEHICLE IDENTIFICATION NUMBER (VIN)
KW6127
COLOR 11 - COLOR 52
TOP ORBOTTOM OR
FRONT: IREARCOLOR:
4
7
LAND
• Attach a copy of the legal description of your land. It can be obtained from your County
Assessor s office.
• Land to which the manufactured home is being:AFFIXED
x
REMOVED
PROPERTY TAX PARCEL NUMBER
45182.0629
TITLE COMPANY CERTIFICATION
I certify that the legal description of the land and ownership are true and correct.
NAME
TITLE COMPANY/PHONE NUMBER
SIGNATURE'...:.::::.. ,..:.:.:.:
X
DATE
NOTE: Application must be finalized with a Licensing Agent within 10 calendar days of the date signed by the Title Company Representative.
BUILD/NG PERMIT OFFICE CERTIFICATION
I ce I that the anufactured home has been affixed to the real property as described, or the
fo owing buildi rmit has been issued for this purpose and will be ins •ected upon completion.
BLDG PERMIT r
Cr`;/ /C/tom
N E �o,�
�Gr'C'/1 pita
SIGNATURE/TITLE''
X SPOKANE COUNTY
BLDG PERMIT O FICE/PHONE NUMBER
ceic.0 I , =tf-,/- 5
DATE
3 p i5
,I `A'(�`A� ON
" "�Y•C.J{
/ D�
"FEES
V�����H�.�F
FILING FEE
COUNTY 5 INC UNINC
(—1 [
NUMBER OF
REGISTERED OWNERS
NUMBER OF
LEGAL OWNERS
PLicensing
Please provide the Department of (DOL)
Client "NUMBER" for each owner:
NAME OFLFIRST REG STERED OWNER
MARTSON, MARY CHRISTINE
MI �i (?i i i lvsjQi �I il<<I�I�
APPLICATION
NAME OF SECOND REGISTERED OWNER
l 1 1 1 1 1 1 I l l l
MOBILE HOME FEES
ADDRESS OF FIRST REGISTERED OWNER
This "NUMBER" may be found on
1322 NORTH ELLA ROAD
your Washington Drivers License/
ELIMINATION
CITY STATE ZIPCODE
I.D. Card --OR-- if the owner is a
business, the Unified
i
SPOKANE WA 99212
provide
USE TAX
NAME OF FIRST LEGAL OWNER•
WASHINGTON TRUST BANK
business identifier(UBI) number.
11111111111
MAILING ADDRESS OF FIRST LEGAL OWNER
P.O. BOX 2127
More than two registered or
SUB -AGENT FEES
1
CITY
SPOKANESTATE ZIPCOOE
A 99210
ono legal owner? . . .
Please use attachment forms
TOTAL. FEES & TAX
•SIGNATURE OF LEGAL OW 9t INDICATES CONSENT FOR I DATE
OF TIT�`E. 001k -INS) �`��(� ���
(TD -420-732)
$ELIMINATION
Anyone who knowinglyrnsl s false statement of a material fact is guilty
of a felony, and upon conviction may be punished by a fine of up to 15,000
and/or 10 years imprisonment (RCW 46.12.210). IDO SOLEMNLY ATTEST
UNDER PENALTY OF PERJURY LAW THAT 1/WE ARE THE REGISTERED
OWNERS OF THIS VEHICLE AND THIS INFORMATION IS A ORATE:
Re 'ate r OOw r Signetur l ' n ///111 (Title)
X1/1 /t, +
DEALE4FS^R» »1LJ OF SALE
C E Lel 1 i .
I cert at IB t is
PURCHASE PRICE
tion
.Torr iq� 1�4p %IIf of
.incum es ex r,as sh6jvn.
t� ,G/ S
TAX JURISDICTION/TAXRATE
: �EALER Si .�O�'tP , . Y"� ;
DATE OF SALE
WASLR 0-"4, ip
It As rI
4145 U1:10HZEa,SIGNATURE
q9A, o _
NsTAA,
�/
`r�•
NT
U -
) scribedand Sworn to Before Me This
� STDay or MARCH 1995
Residing iM1l f �F wiSN
LINCOLItt t ‘ ‘ ‘ v NCbunty
ri—
USE TAX EXEMPT Selo to Indian on the
Reservation (attach notarized statement of delivery)
COUNTY AUDITOR/AGENT LICENS/NG OFF/CE 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 toproceed with the recording of this form.
NAME
SIGNATURE
X
OFFICENFS OPERATOR NUMBER
DATE
RECORDING OFF/CE
This form has been recorded in the county records.
RECORDING NUMBER
COUNTY
VOLUME/PAGE '
0
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