2007, 09-13 MH Applicationm
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My App
RETURN ADDRESS
NUMERICA CREDIT UNION
PO BOX 6011
SPOKANE, WA 99217
ATTN: YEVGENIYA VOROPAY
Ell Department
enoJSH,=GTON MANUFACTURED HOME
ICE S®hG APPLICATION
PLEA SE CHECK' ONE';
M TITLE ELIMINATION •
TRANSFER IN LOCATION •
REMOVAL FROM REAL PROPERTY
a MANUFACTURED HOME
TPO / PLATE NUMBER
$81063
YEAR
1978
MAKE
SEOUA
LENGTH/WIDTH(FEET)
64 X 24
VEHICLE IDENTIFICATION NUMBER(VIN)
748228DS2943
El LAND ADDITIONAL LEGAL DESCRIPTION ON PAGE
TITLE FEES
MANUFACTURED HOME WILL BE J AFFIXED • REMOVED
POPE TY TAx PARCEL NUMBER
55082.1003
FILING FEE
APPLICATION
LOT
BLOCK
PLAT NAME
SECTION/TOWNSHIP/RANGE
MOBILE HOME FEE
A legal description can be obtained from the local County Assessor's Office If there is not enough room here,
use the Application Attachment fo m, TD -420-732, available at your local County Audito 's Office.
LOT .S, BLOCK 9, BARKER ROAD MOBILE HOMES FIRST
ADDITION, AS PER PLAT RECORDED IN VOLUME 9 OF PLATS,
PAGE 70, RECORDS OF SPOKANE COUNTY; INCLUDING
THE MOBILE HOME LOCATED THEREON,
SITUATE IN THE CITY OF SPOKANE VALLEY,
COUNTY OF SPOKANE, STATE OF WASHINGTON.
ELIMINATION FEE
USE TAX
SUB -AGENT FEES
TOTAL FEES B TAX
U GRANTOR(S) REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE'
COUNTY 11
INCORPORATED UNINCORPORATED
9 REGISTERED OWNERS
11 LEGAL OWNERS Iik e.'I' 43
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NAME OF FIRST REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
ADDRESS OF FIRST REGISTERED OWNER CITY STATE ZIP CODE
NAME OF FIRST LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
CAREY, PAUL F CAREYPF665BM
ADDRESS OF FIRST LEGALOWNER CITY STATE ZIP CODE
NORTHC2:5.09=DRUMMOND=# OTIS ORCHARDS WA 90077
GRANTEE(S) ADDITIONAL NAMES ON PAGE
NAME OF FIRST GRANTEE DOL CUSTOMER ACCOUNT NUMBER
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. (RCW 46.12.210)
I DO SOLEMNLY ATTEST UNDER PENALTY OF PURJURY
LAW THAT 1 / WE ARE THE REGISTERED OWNERS OF
THIS VEHICLE AND THIS INFORMATION IS ACCURATE:
SIGNATURE OF LEGAL OWNER INDICATES CONSENT FOR
ELIMINATION OF TITLE / REMOVAL FROM REAL PROPERTY X
//// //J ySIGNATURE OF FIRST REGISTERED OWNER AND TITLE, IF APPLICABLE
X 644-t� A
F
SIGNATOR OF FIRST LEGAL OWNE ND TITLE, IF APPLICABLE SIGNATURE OF SECOND REGISTERED OWNER AND TITLE, IF APPLICABLE
NOTARY SEAL OR STAMP 1
A .� A a
NOTARIZATION / CERTIFICATION FOR REGISTERED OWNER(S) SIGNATURE
/
tale of Washmgion , /����L� Sgnetl or atle /
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county of--<,.C//C, balore me an /_�
on
Notary Public
State of Washington
MARY L PJIFRATKO t
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y I—GLU / �C;�r C)/ signature v yz 'i .. j et, x in,
11DIrneDl Ettpilca Jep 13, LGL'Fi
P nted Name of Appkcanl ealer No OR r`f� /
ills �j t-7�-h.. �l 4.-' AND: County/Off1 a No. OR 4;3i 7
DEALER HIP PosihorppgUeoVNOTARY Notary Expiration Dale
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DEALER'S REPORT OF SALE 1 certify that this Information Is correct. The vehicle is clear of encumbrances except as shown.
DEALER NAME
WA DEALER NUMBER
DATE OF SALE
PURCHASE PRICE
TAX JURISDICTION/TAX RATE
DEALERS AUTHORIZED SIGNATURE
•
USE TAX EXEMPT Sale to a Certified Tribal member on the reservation (attach notarized statement of delivery)
COUNTY AUDITOR/AGENT LICENSING OFFICE APPROVAL: (Not for use by Sub -Agents)
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 OFFICENFS OPERATOR NUMBER
SIGNATURE
DATE
TD -420-729 MANUF HOME APPL (F1/12/96)OR Page 1 of 2
INSTRUCTIONS AND ADDITIONAL INFORMATION ON REVERSE SIDE
U 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 / POSITION DATE
Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs.
6, BUILDING PERMIT OFFICE CERTIFICATION
I certity 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
NAME— BLDG PERMIT OFFICE/PHONE II
�L': IMO_ I-2\ 5CFI - NDS ti O.2-0
SIGNATURE / pliSITIO � /� / D4TE
I" N.C.-11 '-tom, 0,--iinAAI-"c.c./Lyle..cox-6 / els) 0'7
INSTRUCTIONS
COMPLETE THE APPROPRIATE BOXES ON THE FORM AS INDICATED BELOW,
DEPENDING UPON THE TRANSACTION YOU WISH TO PROCESS
A. Manufactured Home Title Elimination Application (complete boxes 1, 2, 3, 4 and 6). Use to eliminate a title for a manufactured
home which is to become real property.
B. Manufactured Home Transfer In Location Application (complete all boxes). Use only when a manufactured home (whose
title has been eliminated) is being moved to land with a different legal description AND will become part of the real property to
which it will be moved and affixed. If the transfer in location is between two different counties, prepare this form In duplicate and
have each recorded in its respective county.
C. Manufactured Home Removal From Real Property Application (complete boxes 1, 2, 3, 4 and 5). Use when titling a
manufactured home whose title has been previously eliminated. Once properly completed and recorded, this application
becomes a supporting document along with others required to apply for a Certificate of Title tor the manufactured home
IMPORTANT: SIGNATURES OF THE OWNERS ON THE MANUFACTURED HOME APPLICATION INDICATE TERMINATION
OF INTEREST IN THE MANUFACTURED HOME THROUGH TITLE PROVIDED BY CHAPTER 46.12 RCW AND INDICATE
INTENT TO PERFECT INTEREST IN THE MANUFACTURED HOME AS REAL PROPERTY WITH THE LAND HE/SHE/THEY
OWN AND TO WHICH IT IS/WILL BE AFFIXED. IF THE MANUFACTURED HOME IS BEING REMOVED FROM REAL
PROPERTY, SIGNATURES OF THE OWNERS PER THE REAL PROPERTY RECORDS INDICATE CONSENT TO THE
REMOVAL. THE FORM MAY THEN BE USED FOR MAKING APPLICATION FOR TITLE WITH THE DEPARTMENT OF
LICENSING AS PROVIDED BY CHAPTER 46.12 RCW.
Note. Owners of the manufactured home must own the land when the application is for a Manufactured Home Title
Elimination or a Manufactured Home Transfer In Location, as provided by Chapter 65.20 RCW
SECTION 1 Enter the description of the manufactured home.
SECTION 2 Place an "X" in the appropriate box and enter the property tax parcel number, lot, block, plat number and
section/township/range, when applicable. Write a legal description in the space provided If there is not enough room,
use the Title Application Attachment (TD0420-732) When processing a'Transfer in Location Application,' both boxes
should be checked. The application must Then be accompanied by two separate land descriptions.
SECTION 3 This area must be signed by all registered owners of the manufactured home when processing a title elimination. If
the manufactured home has been sold and Is being removed from the real property, the owners per the real
property records must complete this portion to obtain a Certificate of TItle. Signatures of the owners must be
notarized or certified by the selling dealer or a vehicle licensing agent Fees will include a filing and application
lee plus sales or use tax due. Additional lees may include: a title elimination tee and a Mobile Home Affairs Fee.
Subagents will charge an additional service fee. (Fees are subject to change without notice.)
SECTION 4 Take the properly completed Manufactured Home Application and all necessary supporting documents to the County
Auditor/Licensing Agent Office for approval. Supporting documents may include but are not limited to. proof of
ownership or a Manufacturer's Statement of Origin (MSO), proof of taxes paid, and applicable release(s) of interest
Subagents may not complete the approval portion of this form.
SECTION 5 The "Title Company Certification" box must be completed when processing a 'Transfer In Location" or a "Removal
From Real Property' application Important: The final recorded application form must be submitted to a vehicle
licensing agent within 10 days of the title company's certification
SECTION 6 When processing an "Elimination" or 'Transfer In Location" application, a city or county office (depending upon the
location of the manufactured home) must certify that the home is affixed to the land:or, issue a building permit to affix
the manufactured home to the land, inspecting the completed attachment. The issuing office must sign the
application, adding the permit number If the inspection has not yet occurred.
IMPORTANT: Once the application has been approved by the County Auditor/Licensing Agent 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,
The Department of Licensing has a policy of providing equal access to its services.
If you need special accommodation, please call (360) 902-3600 or TDD (360) 664-8885
TD -420.729 MANUF HOME APPL (R/12/96)0R Page 1 o12