1995, 10-20 Dept of Licensing MH AppLitivarrL,.„,,,,,,-,
Please
XX
WASHINGTONo
MANUFACTURED HOME
licEnsinc APPLICATION
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)
RECORDER'S CLOCK
FILED AT THE REQUEST OF:
NAME
ADDRESS
MI MANUFACTURED HOME
TPO/PLATE NUMBER
+08457
YEAR
1970
MAKEWIDTH/LENGTH
ELCAR
24/60
VEHICLE IDENTIFICATION NUMBER (VIN)
11063
ElLAND
Attach a copy of the legal description of your land. It can be obtained from County
Assessors office or it may be typed or printed on an Additional
Manufactured home will be 1 AFFIXED
your
Attachment Form (TD-420-732).
REMOVED
PROPERTY TAX PARCEL NUMBER
6-3-1 iA 0 9
x1
Ei TITLE COMPANY CERTIFICATION
I certify that the legal description of the land and ownership is true and correct per the real property records.
NAME
TITLE COMPANY/PHONE NUMBER
SIGNATURE
X
DATE
Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs.
4 BUILDING PERMIT OFFICE CERTIFICATION
I certify that the manufactured home has been affixed to the real property as described, or a building
permit has been issued for this purpose and the attachment will be inspected upon completion.
BLDGPERMIT#
Tr q DP/
NAME
SIGNAITURE/TITLE
.
'la Lt.
Lyog aPERpMIT- OFFICE/PH7ON1E S ,
3&
ATE
---e-76--
OWNER INFORMATION
FEES
COUNTY 1 INC UNINC
II I 1
x REGISTERED OWNERS
1 LEGAL OWNERS
Provide the Washington Driver's License or I.D.
card number (PIC) for each owner:
FiLING FEE
NAME OF FIRST OWNER
ROBERT A. BOYETTE
&)/e7-P,A 71 7
APPLICATION
NAME OF SECOND OWNER
CAROLE M. BOYETTE
F:80 ))1-f7 e--P) 5 S
MOBILE HOME FE S
I
ADDRESS OF OWNER
17324 EastCoach Drive
--OR-- if the owner is a business,
ELIMINATION
o CITY
Greenacres
STATE
WA
ZIP CODE
99016
provide the Unified Business
Identifier (UBI), found on the
business Registration & Licenses
USE TAX
NAME OF FIRST LEGAL owNEa•
SPOKANE RAILWAY CREDIT UNION
Document,
SUB-AGENT FEES
MAILING ADDRESS OF FIRST liGAL OWNER
H 301 North Havana
More than two owners or one
Iienholder? Please use attachment
TOTAL FEES TAX
CITY
STATE
ZIP CODE
form(s) #TD-420-732.
$o
Spokane
WA
99202
DEALER'S REPORT OF SALE
R•SIGNATUR OF LEGAL OWNER INDICATES CONSENT FOR ELIMINATION OF TITLE/REMOVAL
I certify that this information is cor ect. The vehicle is clear
FROM REAL PROPERTY
ca......—..---.--•Qa------...-------'"
of encumbrances except as shown.
Anyone who knowingly makes a false statement of a material fact is guilty of a felony,
upon conviction may be punished by a fine of up to $5,000 and/or 10 years imprisonment
(RCW 46.12.210). I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY
WA DLR NO
DATE OF SALE
PURCHASE PRICE
LAW
THAT I/WE ARE THE RE ISTERED OWNERS OF THIS VEHICLE AND THIS INFORMA-
TIO S . T'‘' • r g e(5) 8. Title(s)
DEALERA E
TAX JU I DICTION/TAX RATE
i/
X
DEALER'S AUTHORIZED SIGNATURE
-
'"?....14.
• WW1,/
X I
X A , ,
USE TAX EXEMPT Sale to a Certif., . .,:,,.. : b • 4,
the reservation (attach notarized st- :.,.;i4, • • • 0 0.
NOTARY 0 ENSEAGENT&NUMBER
/ ,.._
SUBSCRIBEDTO 0
DAY 0
ORN BEFOR M T
e in in ounty '
. § ...
.3 .: 1% OTapAR k. i
OUNTY AUDITO • = GENTLICENSING OFFICE APPROVAL: (Not for use by Sub-Agents) ' PUBL1 . ,
-_.-.
...
.,.,
I certify that the above application appears to have been completed correctly, and the applicant has su _ j: pri.unerktzajoo'riA§"
proceed with the recording of this form. "re tk• '•‘1. ' .' \-‘
°P
NAME
SIGNATURE"fe,
X
OFTICENFS OPERATOR NUMBER
W
DA Ni 1100
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