2005, 07-01 Dept of Licensing MH AppRETURN ADDRESS
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147 STATE OF WASHINGTON
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MANUFACTURED HOME
APPLICATION
statement of a material fact is guilty
be punished by a fine, imprisonment,
zhjTITLE
REMOVAL
(RCW
PLEASE CHECK ONE
ELIMINATION
IN LOCATION
FROM REAL PROPERTY
46.12.210)
■TRANSFER
•
Anyone who knowingly makes a false
of a felony, and upon conviction may
or both.
1 MANUFACTURED HOME
TPO/ PLATE NUMBER
YEAR
1983
MAKE
.GTIDWEST
LENGTH/WIDTH(FEET)
24 X 56
LEGAL
VEHICLE IDENTIFICATION NUMBER (VIN)
SM4R1
DESCRIPTION ON PAGE
66268
LAND
MANUFACTURED HOME WILL BE AFFIXED
�k551
PROPERTY TAX PARCEL NUMBER
REAL55172
z2. n.rm
• REMOVED
LOT
1
BLOCK
1
PLAT NAME
MISSION VISTA
SECTION/TOWNSHIP/RANGE
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
HAWKINS. CODY D.
NAME OF ADDITIONAL REGISTERED OWNER
SEARLS, KENDRA B
ADDRESS CITY STATE ZIP CODE
1523 NORTH GRADY ROAD GRFFNACRFS WA 99016
NAME OF LEGAL OWNER
MAJOR MORTGAGE
NAME OF ADDITIONAL LEGAL OWNER
ADDRESS CITY STATE ZIP CODE
3101 YELLOWSTONE RD #LL1 CHEYENNE WY 89009
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 I / WE AM ARE THE R (STEREO WNER(S) OF THIS
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APPLICABLE �"
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APPLICABLE �1 n�r�(d1w.
NOTARY SEAL OR STAMP
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G`L�f.,,�J,,,,
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i,,,..j NOTARIZATION/CERTIFICATION
1 1j' -I ,tat of Washington
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-1061.. County of
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FOR REGISTER
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6i
OWNER(S)
Signed or attested
before,
SIGNATURE
I
eon 7�/ �S
late / Signatur-
v
by
Title
NOTARY OR AGENT
P -f TNA O - GISTEREDOWN-
PRINT NAME QF GISTERED OWNER PRINTED
1l/d i ZG'iy
NAME OF
OF
County/Office
AND:
Notary
WortARV
N
No. OR
Dealer No OR
DEALERSHIP POSITION/ ENT/NOTARY
Expiration Date -. e v.c.t _)
4 TITLECOMPANY 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.
$ BUILDING PERMITOFFICE CERTIFICATION
I certify that: 0 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 will be inspected upon completion.
NAME (TYPED OR PRINTED) BLDG PERMIT OFFICE/PHONE ll
.:3rc'�'l \t\ Ak.-s (r39 -CC; (_.r
BLDG PERMIT II
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51G URE/POSITION .� DATE
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TD:aZbt29 MANU
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