2008, 07-28 Dept of Licencing MH AppAFTER RECORDING MAIL TO:
First American Title Company
12209 E. Mission #3
Spokane, WA 99206
Filed for Record at Request of:
First American Title Insurance Company
Space above this line for Recorders use on/y
MANUFACTURED HOME
PLEASE CHECK ONE
r''`''"'""rTITLE
APPLICATION
IICEDSianG
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.
X
ELIMINATION
TRANSFER IN LOCATION
REMOVAL FROM REAL PROPERTY
(RCW 46.12.210)
1
MANUFACTURED HOME
TPO/PLATE NUMBER
9/o46433
YEAR
1970
MAKE
CHATU
LENGTH/WIDTH (FEET)
62 y 24
VEHICLE IDENTIFICATION NUMBER (VIN)
$4279
Q LAND LEGAL DESCRIPTION ON PAGE 2
MANUFACTURED HOME WILL BE
X
AFFIXED REMOVED
REAL PROPERTY TAX PARCEL NUMBER
55192.0910
LOT
10
BLOCK
2
PLAT NAME OR SECTION/TOWNSHIP/RANGE
Apple Valley Estates//
OUARTER/OUARTER SECTION
3
GRANTOR(S) REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE
COUNTY NUMBER
0144
NUMBER OF REGISTERED OWNERS
2
NUMBER OF LEGAL OWNERS
0
NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
Gary Demain
NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
Shirley Demain
ADDRESS CITY STATE ZIP CODE
17420 East Coach Drive, Spokane Valley, WA 99016
NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
ADDRESS CITY STATE ZIP CODE
GRANTEE
NAME
N/A
I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT I/WE A /ARE THE REGISTERED OWNER(S) OF
THIS VEHICLE AND THIS INFORMATION IS ACCURATE: / ,
Signature of Registered Owner and Title, IF APPLICABLE L 26 Z Q
-r
Signature of Additional Registered Owner and Title, IF APPLICABLE dram/
' 0 m/1
NOTARY Wit, OR STAMP 1 NOTARIZATION/CERTIFICATION FOR REGIS RED OWNER S) SIGNATURE
�0 11I71I11!!/tt7 ested
`.�N�GHEN S4To State of WashingtonCounof Spokane Sign
,befo e�m�dn 9/7/06
` . �yS10N E,iA 9y2 1.. by i by Gary Demain Signature .. C ' f t ', ,. ' i 1
(, ,'t t-?
,
pi �OTARy 9o" I PRINT NAME OF REGISTERED OWNER ✓ ' NOTARY OR AGENT
Z:I by Shirley Demain Gretchen Satran
F —•— =1 PRINT NAME OF REGISTERED OWNER PRINTED NAME OF NOTARY
PUBLIC, - 1 County/Office No. OR
t1 .� A.1 Title Notary AND Dealer No. OR 5/19/09
4•
�i� 1)...",1.)' 19 2 . i DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Date
7_ ••� tl
M�,�,,� .z.
/ ii �► s' ERTIFICATION
I certify ffittluthot1 j description of the land and ownership is true and correct per the real property records.
NAME (TYPED OR PRINTED) TITLE COMPANY/PHONE NUMBER
Sherry Stolz, First American Title Insurance Company (509)838-5281
SIGNATURE/POSITION DATE
Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs.
5
BUILDING PERMIT OFFICE CERTIFICATION
the manufactured home has been affixed to the real property as described.
I certify that:
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 #
----),L_A.J
BLDG PE MIT #,
Se (c' .) _ ATE
SIGN RE/POSITION...4 A? ---/ y 1 cst .L_Ki.)
TD -42729 MANUF HOPPL (R/2/02)OR (W)Page of 2
First American Title File No. 4253-894146 (GS)
MANUFACTURED HOME — FROM SECTION 1
TPO/PLATE NUMBER
%46433
YEAR
1970
MAKE
CHATU
LENGTH/WIDTH (FEET)
62 X 24
VEHICLE IDENTIFICATION NUMBER (VIN)
$4279
6 SIGNATURE OF LEGAL OWNER
SIGNATURE OF LEGAL OWNER INDICATES CONSENT FOR ELIMINATION
Signature of Legal Owner and Title, IF APPLICABLE
Signature of Additional Legal Owner and Title, IF APPLICABLE
OF TITLE/REMOVAL FROM REAL PROPERTY.
NOTARY SEAL OR STAMP I
I
State of Washington
by
NOTARIZATION/CERTIFICATION FOR LEGAL OWNER(S) SIGNATURE
Signed or attested
County of Spokane before me on
Signatur
e
PRINT NAME OF LEGAL OWNER NOTARY OR AGENT
by
PRINT NAME OF LEGAL OWNER PRINTED
Title Notary AND
NAME OF NOTARY
County/Office No. OR
Dealer No. OR
Notary Expiration Date
DEALERSHIP POSITION/AGENT/NOTARY
7 LAND DESCRIPTION (A legal description of the land can be obtained from the local County Assessor's Office)
LOT 10 IN BLOCK 2 OF APPLE VALLEY ESTATES, ACCORDING TO PLAT RECORDED IN VOLUME 9 OF PLATS AT PAGE(S) 26, IN
THE CITY OF SPOKANE VALLEY, SPOKANE COUNTY, WASHINGTON.
8 DEALER'S REPORT OF SALE
I CERTIFY THAT THIS INFORMATION IS CORRECT. THE VEHICLE IS CLEAR 0 ENCUMBRANCES EXCEPT AS SHOWN. ANY
REQUIRED SALES TAX HAS BEEN COLLECTED.
DEALER NAME (TYPED OR PRINTED)
WA DEALER NUMBER
DATE 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 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 (TYPED OR PRINTED)
COUNTY OFFICE/VFS OPERATOR NUMBER
SIGNATURE
DATE
10 TITLE FEES
FILING FEE
APPLICATION
MOBILE HOME FEE
ELIMINATION FEE
USE TAX
SUBAGENT FEES
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.
TOTAL FEES & TAX
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 fee.
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 of Licensing has a policy of providing equal access to its services If
you need special accommodation, p/ease call (360) 902-3600 or TDD (360) 664-8885.
TD -420-729 MANUF HOME APPL (R/2/02)OR (W) Page of 2