2006, 06-19 Title EliminationRETURN ADDRESS
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76746" 6
MANUFACTURED HOME PL AS CH CK ONE
Lh1STTrOF f.SHINCTON
APPLICATION
ticEnsi'G._
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
ELIMINATION
�TINLOCATION
TRANSFER
REMOVAL FROM REAL PROPERTY
both. (RCW 46.12.210)
1
MANUFACTURED HOME
TPO / PLATE NUMBER
&102701
YEAR
1998
MAKE
GoldenWest
LENGTH/WIDTH(FEET)
48 X 27
VEHICLE IDENTIFICATION NUMBER (VIN)
GW0R23N19373
2
LAND LEGAL DESCRIPTION ON PAGE 2
MANUFACTURED
HOME WILL BE VA AFFIXED
Ia
REMOVED
REAL PROPERTY TAX PARCEL NUMBER
55192.1202
LOT
2
BLOCK
1
PLAT NAME OR SECTION/TOWNSHIP/RANGE
Apple Valley Estates
QUARTER/QUARTER SECTION
3
GRANTOR(S) REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE
COUNTY NUMBER
NUMBER OF REGISTERED OWNERS
2
NUMBER OF LEGAL OWNERS
1
NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
Albert Atencio
NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
Shirley Atencio
ADDRESS CITY STATE ZIP CODE
315 South Flora Road Greenacres WA 99016
NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
Boeing Employees' Credit Union
NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
ADDRESS CITY STATE ZIP CODE
12770 Gateway Drive, MS 1052-1 Tukwila Wa 98168
GRANTEE
NAME
I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT I / WE AM/ARE THE REGISTERED OWNER(S) OF THIS
VEHICLE AND THIS INFORMATION IS ACCURATE:
Signature of Registered Owner and Title, IF APPLICABLE -
Signature of Additional Registered Owner and Title, IF APPLICABL .' . I. , elltilkilial
NOTARY STAMP 1 NOTARIZATION/CERTIFICATION FOR RE e• TERED OWNER(S) SIGNATURE
``�� e.'.........9 �� IN'a�,'G State of Washington (� ,ry /�� Igned or attested /G�
40).%. e i` I County of �) 'KGL b for me on / U
`� vsT' ��WON
� �� �t,Y��ir'�es • j b ;N7b6,' /a��Q Signature ��/�i��i�!l �, _,,,
OWNER / i r- I•'' T
-+0�- PRINT ME OF REGIST)-t,'tt
'; by) S !" /1 t/ ,
•
T.i th:..-9,p �,' „.1 PRIAYNA E OF REGISTERED OWNER PRINTED E OF NOTARY
�!i %,ffi•. `... ja............�� I / Count /Office No. OR /
,,,,„ e to```Title C� ' C/� AND: County/Office
No. OR '//z> Y
/%It7r- w iik 4100 I DEALE HIP POSITIO /AGENT/NOTARY Notary Expiration Date
4
TITLE elAIOUIY 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
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
I certify that:' ne manufactured home has been affixed to the real property as described.
® a building permit has been issued for this purpose and the attachment will be inspected upon completion.
,�f
, I JC i � U U `) ` A s�
NAME ( PED PRINT !� BLDG PERPEIT OFFFIICE//ca,
BLDG PERMIT
�LJ:J 7 L-
SIGNAT R
a ca,_.4.„,,,1/4,A--/PHlON}E(#,
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