1995, 02-22 Dept of Licensing MH App��Vart 0nrNolSNLVGTnN MANUFACTURED HOME
I CEfSiflG APPLICATION
RECORDER'S CLOCK
FILED AT THE REQUEST OF:
NAME
ADDRESS
Please
X
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)
i MANUFACTURED HOME
TPO/PLATE NUMBER
YEAR
1984
MAKE
BUDDY
WIDTNILENGTH
14/70
VEHICLE IDENTIFICATION NUMBER (VIN)
0496-0173-R
'IV 5 LAND
Attach a copy of the legal description of land. It can be obtained from Coun
Assessor's office or it may be typed or
Manufactured home will be
your
printed
x
your y
on an Additional Attachment Form (TD -420-732).
AFFIXED REMOVED
PROPERTY TAX PARCEL NUMBER
55172.0607
I I
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
X
DATE
Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs.
BUILDING PERMIT OFFICE CERTIFICATION
I certify 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.
BLDG PERMIT.
94).A.- 1/4 L
NAM' //7/' i /` // /�.. �)I
1l. Uw/ .uj(��)[.(.iC
�SIG
/'U//A/ TU{RR/ERI-TTLLE. l/�� c}�/��/ NE TNMERMIT OFFICE/PHONE N
-!.A/rA/✓✓I /l ISIO 11`11.+�OV Y71- 1-1&_.0-7';/0
C OF BUILDINCAS7J9) -167.0,for
DATE
i f
09- , cls
/r/ DIVISION
"$5' O NER INFORMATIO
FEES
COUNTY c INC UNINC
❑ ❑
xRE STEREO OWNERS
2
A LEGAL OWNERS
1
Provide the Washington Drivels License or I.D.
card numbe (PIC) tor each owner:
FILING FEE
v NAME OF FIRST OWNER
cR. ,. Zuhlke, Gary .E.,
deceased
APPLICATION
I
G,. NAME OF SECOND OWNER
,.T. Zuhlke, Carla
deceased
MOBILE HOME FEES
7E .% ADDRESS OF OWNER
Rr, 1410 N. Grady Road
' E*
--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 a Licenses
USE TAX
sj„{q NAME OF FIRST LEGAL OWNER'
-I
J
-<;. Douglas Enterprises, Inc.
Document.
SUBAGENT FEES
I
MAILING ADDRESS OF FIRST LEGAL OWNER
-iMTMore
o(' 422 W. Riverside, Suite 904
than two owners or one
lienholder? Please useatlachment
OTAL FEES & TAX
4t._., cry a
STATE
zip CODE
form(s) #TD -420-732.
Q
Spokane
WA
•,9201
DEALER'S REPORT OF SALE
IQDr
•SIGNATURE OF LEGAL OWN - A T •.. A
fj[ri'R4�1 `, �s {S : /f.... _
t. FROM REAL PROPERTY XBy �'
certify that this information Is correct. The vehicle is clear
of encumbrances except as shown.
Anyone who knowingly makes a false slatment of a material fact is guilty of a . ony, and
upon conviction may be punished by a fine of up to $5,000 and/or 10 years imprisonment
(RCW 46.12.210). I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY LAW
THAT I/WE ARE THE REGISTERED OWNERS OF THIS VEHICLE AND THIS INFORMA-
TIO Ly T ' ��,,[[ 9 la Ideal:
C HL( )� RLA ZUHL1'tE. DECEASED
WA DLR NO. -
DATE OF SALE
PURCHASE PRICE
$
DEALER NAME
TA%JURISDICTIONrtAX RATE
DEALERS AUTHORIZED SIGNATURE
X
X eon R. erael au, personal Rep.
USE TAX EXEMPT Sale to a Certified Tribal member on
the reservation (attach notarized statement of delivery)
X
NOTARY O •' CENSE AGENTS NUMBER
SUBS51tEO TO ANDS RN EFORE ME THIS
0702 DAY Of 995
Resiamg m (County)
Spokane
X Li
C. UNTY AUDITOR/AGENT LICEN G OFFICE APPROVAL: (Not for use b Sub -Agents)
I certify that the above application appears to have bee 6 Ig• co and the applicant has sufficient documentation to
proceed with the recording of this form.
NAME
SIGNATURE ~,-. .
OFFICENFS OPERATOR NUMBER
DATE
X
(RR/94)M Paga i 0