1995, 05-10 Manufactured Home AppLt
2
A
l,9
1
When Recorded Return To: • WALDO AND SCHWEDA2 P.S.
LUU 1 11\LU nun,
STATE OF WASHINGTON
pepazimerr of SPOKANE, WA 99206
lC .........'..... MANUFACTURED HOME APPLICATION,
RECORDER'S CLOCK
,
,. • ,
9.? � t ' ' � • .
'
- I '
RECORDED AT'
REQUEST OF:
TITLE
OPTIONS' `
Original '
Transfer
Duplicate "
Reissue
®
—
I. •• ''• .• , .
TITLE ELIMINATION (Complete all but section 3, below)
TRANSFER IN LOCATION (Complete ALL sections below)
REMOVA 0 OP tarnto all but section 4, below)
I I,`x_1It 4 ,'
• MANUFACTURED HOME
YEAR
MAKE '•'
;HAMPION '
WIDTH/LENGTH
'28x52
VEHICLE IDENTIFICATION NUMBER WINI
1644364315IDA
COLOR 81 . ... COLOR 82
FR FROP NNT:T: 1REAR COLOR:
OR84
•
. LAND
Attach a copy of the legal description of your land. It can be obtained from your County
office
•
Land to which the manufactured home is being: AFFIXED
REMOVED
-Assessor's
PROPERTY TAX PARCEL NUMBER
I
TITLE COMPANY CERTIFICATION
certify that the legal descrip ion 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.
BUILDING PERMIT OFFICE CERTIFICATION
I
fol
ce ify that the ma factured
.wing building fi ' it has
home has been affixed to the real property as described, or the
been issued for/ t(hiis/�p[urppose��ELand be inspected upon completion.
BLDG PERMIT a
91008467/
N
E
.l t /
!,/ . ...lit/
v NATUR; ITg '.
NE
A
BLDG O1 IT FFI�PHONE -2� / 5
DATE �.4/ 5
NdR�Iwill
F'fiir-DOUNTY/VFVHM
OWNER! •N
•F S
FILING FEE
COON F IINC UNINC
f-1 El
NUMBER OF
REGISTERED OWNERS
1
1
NUMBER OF
LEGAL OWNERS
1
Please provide the Department of Licensing (DOL)
Client "NUMBER" for each owner: '.
'
i'ft
i
NAME OF FIRST REGISTERED OWNER .
SCHOEN, Monica M.
. _ ' '
1 1 1))) 1 1 1
APPLICATION
4'
NAME OF SECOND REGISTERED OWNER
I
IF
El
11111111111
MOBILE HOME FEES
i
ADD FI R
P' 0 Box 1502
This "NUMBER" maybe found on
I
EX��r�XDS��di�4�
IRS
your Washington Drivers License/
ELIMINATION
HET
D
CITY
Spokane
STATE 21PCODE
WA; 99210
I.D. Card --OR-- if the owner is a
business, the Unified
provide
USE TAX
y
NAME F I CAL WNEB•
gCFI ,.Monica M.
-
business idontifier(UBI) number.
I I I I I, 1 1 1
a
L�,+
yahsame
MAILING ADDRESS OF FIRST LEGAL OWNER
"'
� - • '
More than two registered or
SUB -AGENT FEES
- - l
•LAT
4
CITY
. STATE ZIPCODE
n
one legal owner7'....
Please use aitachment forms
TOTAL FEES & TAX
t.�8(y,),
•SIGNATURE OF LEGAL OWN�` I�NJ ICATES
ELIMINATION OF TITLE: "X,li
CONSENT ,FO`R TE
)/ �g�Ln/
LTD -420.732) .
'.
-
$
",„.'GCt/.�
Anyone who knowingly makes a false statement
of a felony, and upon conviction may be punished
and/or 10 years imprisonment (ROW 46.12.2101.
of a material act is guilty
by a fine of up to $5,000
1 DO SOLEMNLY ATTEST
DEALER'S REPORT OF SALE
•$
I certify that this Information is '
PURCHASE FSVCE
,
UNDER PENALTY OF PERJURY LAW THAT
OWNERS OF THIS VEHICLE AND THIS INFORMATION
Registered Owns, SlanaturNel:
I/WE ARE THE REGISTERED
IS ACCURATE:
(Title I
correct. The vehicle is clear of
encumbrances except as shown.
TAX JURISDICTION/TAX RATE
X
DEALER NAME ..
DATE OF SALE
X • : .. -
WA DIA HIO::
DEALER'S AUTHORIZED SIGNATURE v--'
a
X
NOTARY CR LICENSE AGENT & NU?ABER
X
Sub c,l)wd and Sworn to Before Me This
/0 F'Dey of May tB 95
Residing in
- Spokane County
USE TAX EX
Reservation (attach
PT sea
notarized
to
slat
n
mans of deliveryl
COUNTY AUDITOR/AGENT LICENSING OFFICE 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 to proceed with the recording of this form.
NAME .. ..,:.
SIGNATURE "+' • • :: v...:...
X
OFFICENFS OPERATOR NUMBER .
DATE
RECORDING OFFICE
This form has been recorded in the county records.
RECORDING NUMBER...': ' - -. ... -
COUNTY
VOLUME/PAGE
DATE
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