2007, 10-24 Title EliminationRETURN ADDRESS
ANSNATION NORTH
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SPOKANE, WA 99205
��77 57ATCOFWASHINGTON
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YCEBSIDG
MANUFACTURED HOME-
APPLICATION
statementof a material fact is guilty
may be punished by a fine, imprisonment,
TITLE
(RCW
PLEASE CHECK ON
ELIMINATION
IN LOCATION
FROM REAL PROPERTY
46.12.210)
■TRANSFER
■REMOVAL
Anyone who knowingly makes a false
of a felony, and upon conviction
or both.
D MANUFACTURED HOME ,
TPO / PLATE NUMBER
YEAR
1'7 2? i
MAI.KE
«bD'y
LENGTH/WIDTH(FEET)
676)X 4
VEHICLE IDENTIFICATION NUMBER .VIN)
0 4 96° 334
2 LAND LEGAL DESCRIPTION ON PAGE
MANUFACTURED HOME WILL BE AFFIXED
REAL PROPERTY TA ARRCEL NUM ER
'ra`"o c7 /. / v
• REMOVED
LOT
—
BLOCK
o2.
PLAT NAME OR SECTION/TOWNSHIP/RANGE
FA i Ie Hcre€-s MO h'i I e.. Ii et) rnz_4
QUARTER/QUARTER SECTION
Ej GRANTOR(S) REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE
COUNTY NUMBER
NUMBER OF REGISTERED OWNERS
NUMBER OF LEGAL OWNERS
NAME OF REGISTERED OWNER kl,A )J t y{�DOL CS)fa0 ((�CtUQ NUMBER
_S e 'Fri y L rn iR 1 S \ k'H i2 Y !('_ A v n ,A1tt s4- JK ..�. '/a ,s'�. ,+ rya=
NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
116 1 % I_ E,eirt , fv 4 6 v -Q_ okiaN e__ V A f k_\i t,\J A. q ' 2 0
ADDRESSCITY STATE ZIP CODE
f C N I 't' N tl 11 L. (Ai f ti S 'L.r V i C.€ S Cif_' 0 i t (,C N i o .4
NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
ADDRESS CITY STATE ZIP CODE
a a -
6,, is S. WA S I1 i ry c- f o po r1CHrvL ti/,I c7 9 -i
GRANTEE
NAME
I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY
VEHICLE AND THIS INFORMATION IS ACCURATE:
Signature of Registered Owner and Title, IF
Signature of Additional Registered Owner and Title, IF
THAT f / WE • , RE THE REGIST RED OWNER(S) OF THIS
• n
/ �/
APPLICABLE r'�/ij^
, / I
bL'LA,_)
APPLICAB �'
NOTARY SEAL OR STAMP1
_ I State
�, _..' -- -I
B. C.BERN41:�,
TATE OF WASHiN .fby`
J NOTARY"-°- PUB
PUBL_+ y
I MY COMMISSION EXPIRES 05.19.09
I
-i -Titl�
NOTARIZATION/CERTIFICATION
of Washington
- County of
J 'eNA.ME �ISTERED
ATION F• ' REGI
y
\'7 -
Tk ED OWNERS
OWNER(S)
Signed or attested
before
SIGNATURE
S {�� /Q G
me on
L M A `) S Signature
KY,0‘,-,A_A—_
P OF OWNER N RY OR AGENT
i K 1a ie y S m A y S B C rz r rt, l �,
PRINT NAME OF REGISTERED OWNE 'PRINTED
/JC/ � �`�''Le�
NAME OF
County/'Office
AND:
Notary
NOTARY
No. OR
Dealer No. O�J `��% v`7
DEALERSHIP POSITION/AG
Expiration Date
4 TITLE COMPANY CERTIFICATION
I certify that the legal description of the land and ownership is true and correct per the real property records.
NAME (TYPED OR PRINTED) TITLE COMPANY / PHONE NUMBER
-SiL.NATURE / POSITION DATE
Kir aline this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs.
BUILDING PERMIT OFFICE CERTIFICATION
ithilcertlfy that CI the manufactured home has been affixed to the real property as described.
0 a building permit has been issued for this purpose and the attachment wit be inspected upon completion.
.NAME (TYPED"OR PRINTED) BLDG
• -,, VA n E-.
PERMIT OFFICE/PHONE #
F> --(c '-0 2.C_3
i--- L.,C1:-.i..c-=_.)6 -
I
BLDG PERMIT #
Los- LI it ;:3
DA E
I ..`� c1
L l �4_ 1
SIGN/VT
f
CIA
E / SITIO7P7 I
3i /1 \/
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TD•420 rMANUFHOME PPL(R/2/02)OR(W)Page 10