1995, 07-27 Title Eliminationprfinenfof5111.=
Please
GTO N MANUFACTURED HOME
IkFJlSiflG 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
1 MANUFACTURED HOME
TPO/PLATE NUMBER
YEAR
1976
MAKE
BILTM
WIDTH/LENGTH
70x14
VEHICLE IDENTIFICATION NUMBER (VIN)
613235
2 LAND
Attach the legal description land. It be from County
a copy of of
Assessor's office or it may be typed or
Manufactured home be
your
printed
x
can
on an Additional
AFFIXED
obtained your
Attachment Form (TD -420-732).
REMOVED
PROPERTY TAX PARCEL NUMBER
55192. 1203
will
3 TITLE COMPANY CERTIFICATION ...illialailli
I certify that the Iega' jescription of the land and ownership is true and correct perk,-- - •roo 'cords.
�� , .�
TITLE COMPANY/PHONE NUMBER
Pioneer Title 838-5281
SIGNATUREsirjur DATE
X ��r.7 1? 11\
Finalize this application with a Licensing Agent within 10 calendar days of the • Company Representative signs.
4 BUILDING PERMIT OFFICE CERTIFICATION
1 certify that the manufactured home has been affixed to the real property as described, or a building
issued for this purpose and the attachment will be inspected upon completion.
per it has been(PAW
BLDG PERMIT# l
jj 3C0 8(
N•
tt'0
SIGNATURE/TITLSPOKANE COUNTY
X DLUISION-OF BUILDIN
�U
BLpGPER IT OFFICE/PHONE#
( `gills /4 Stl- %757
DATE
ig 1 I
1$ OWN ,I7 INFORMATION i `�
1
FEES
COUNTY>r INC UNINC
I 1 1,c1
# REGIST RED OWNERS
4 LEGAL OWNERS
Provide the Washington Driver's License or LD.
card number (PIC) for each owner:
FILING FEE
NAME OF FIRST OWNER
E Bryan L. Nye
APPLICATION
C" NAME OF SECOND OWNER
I
S
MOBILE HOME FEES
E ADDRESS OF OWNER
E
R 305 S. Flora Rd.
--OR-- if the owner is a business,
ELIMINATION
0 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 OWNER'
Norwest Mortgage
Document.
SUB -AGENT FEES
eMAILING ADDRESS OF FIRST LEGAL OWNER
H 901 N. Monroe #250
0
More than two owners or one
lienholder? Please use attachment
TOTAL FEES & TAX
L CITY
STATE
ZIP CODE
form(s) #TD -420-732.
$
e Spokane
WA
99201
DEALER'S REPORT OF SALE
R 'SIGNATURE OF LEGAL OWNER ID 1 GATES CONSENT F' R ELIMINATION OF TITLE/RE VAL
FROM REAL PROPERTY: xe, % Jt1rr/4-i �,;,-
I certify that this information is correct. The vehicle is clear
of encumbrances except as shown.
Anyone who knowingly makes a fats ement of a material f • is guilty df a fe n , and
upon conviction may be punished b ne of up to $5,000 an or 10 years imp is nment
(RCW 46.12.210). I DO SOLEMNLY ATTEST UNDER PENALTY
A DLR NO.
DATE OF SALE
PURCHASE PRICE
OF PERJURY LAW
THAT I/WE ARE THE REGISTERED OWNE: OF THIS VEHICLE AND THIS INFORMA-
TION IS ACCURAF Owner Signotur. & Title(s):
DEALER NAME
TAX JURISDICTION/TAX RATE
g...-
DEALER'S AUTHORIZED SIGNATURE
,ain
X
X -')
USE TAX EXEMPT Sale to a Certified Tribal member on
the reservation (attach notarized statement of delivery)
NOTARY • LICENS GENT 8 N M:ER
X �' i
SUBSC A I: /TO ANW
D OHN BEFORE ME THIS '
`_DAY �F /,/fir 1995
Residing in (County)
6 COUNT AUDIT*R/AGENT L ENSI O
FICEA' ROV -: (Not for use by Sub -Agents)
1 certify that the above applicati• app". • ~ - been ompleted correctly, and the applicant has sufficient documentation to
proceed with the recording of thi . tt pubite-Stateotwutdagt"
NAME
My
mlC;fJAIL1pF_ "41
ISSI011 GiV�IE3
OFFICENFS OPERATOR NUMBER j DATE
IL
TD -420-729 MANUF HOME APPL (R/2/94)M Page 1 of 2