1994, 03-24 MH ApplicationL7STATEOr W4SHINGTON
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IICEflSIflG MANUFACTURED HOME APPLICATION
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5
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TITLE OPTIONS
Original
Transfer
Duplicate
Reissue
11 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)
RECORDEWS CLOCK
RECORDED AT
REQUEST OF:
MANUFACTURED HOME
YEAR
1987
MAKE'
WYNNE
WIDTH/LENOTN < ..
28/56
VEHICLE IDENTIFICATION NUMBER (VIN)
11812438
COLOR 51 <.
TOP OR
FRONT:
COLOR 82
BOTTOM OR
REAR COLOR:
LAND
• Attach a copy of the legal description of your land. It can be obtained from your Cou-1ty
Assessor's office.
• Land to which the manufactured home is being:) AFFIXED
REMOVED
PROPERTY TAX PARCEL NUMBER
TITLE COMPANY CERTIFICATION
I certify that the legal description of the land and ownership are true and correct.
NAME ". —
'' ''
:TITLE COMPANY/PHONE:NUMBER ,. ':<
SIGNATURE ^i ;-. <'!: ;;.. !'
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 ce fy that the manufactured home has been affixed to the real property
fol owin. build' •. • ermit has been issued for this • ur • ose and will be ins
as described, or the
ected u a on com a letion.
s . • PERMIT r
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dIGNATUREMTLEBLDG
x SPOKANE COU�r
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COUNTY R I INC UNINC
❑n
•FEES
NUMBER OF
REGISTERED OWNERS
NUMBER OF Please provide the Department of Licensing (DOL)
LEGAL OWNERS Client "NUMBER" for each owner:
NAME OF FIRST REGISTERED OWNER
HAEFELE, LOREN J.
FIUNG FEE
NAME OF SECOND REGISTERED OWNER
HAEFELE, JESSIE M.
ADDRESS OF FIRST REGISTERED OWNER
N. 123 Herald
CITY
Spokane
STATE ZIPCODE
WA 99206
NAME OF FIRST LEGAL OWNER*
SECURITY PACIFIC HOUSING SERVICES/SHIRLEY STAATZ
1 1 1 1 1 1 1 1 1 1 1
MAILING ADDRESS OF FIRST LEGAL OWNER
P. 0. Box 1310
CITY
Vancouver
STATE ZIPCODE
WA .98666
*SIGNATURE OF LEGAL OWNER NQIC TES CrN•ENT •11 TE
ELIMINATION OF TITLE: X,1 yr w
Anyone who knowingly makes a false i7 tement of aterial fact is guilty
of a felony, and upon conviction may be punished by a fine of up to 55,000
and/or 10 years imprisonment (RCW 46.12.2101. I DO SOLEMNLY ATTEST
UNDER PENALTY OF PERJURY LAW THAT I/WE ARE THE REGISTERED
OWNERS OF THIS VEHICLE AND THIS INFORMATION (TH�*ISACCURRA/��TEE:
ulster Owns, ..�/; 1
V !) ►'",r9(
hv
This "NUMBER" may be found on
your Washington Drivers License/
I.D. Card --OR-- if the owner is a
business, provide the Unified
business identifier(UBI) number.
1 1 1 1 1 1 1 1 1 1 1
More than two registered or
one legal owner? .. .
Please use attachment forms
(TD -420-732)
APPLICATION
MOBILE HOME FEES
ELIMINATION
USE TAX
SUB -AGENT FEES
—j
TOTAL FEES & TAX
X
X RR,,
NOTARY eR UCENCU
X 71i
MARY A. WHITING
t:(7101MISSl
aLJikibed and iworn to Before Me This
IJ of 014/1a. 19 9`%
DEALER'S REPORT OF SALE
I certify that this information is
correct. The vehicle is clear of
encumbrances except as shown.
PURCHASE PRICE
TAX JURISOICTION/TAX RATE
%DEALER. NAME
DATE OF SALE
WA DLR NO:
Residing in
DEALER'S AUTHORIZED SIGNATURE.
X
County
USE TAX EXEMPT Sele to Indian on the
Reservation (attach notarized statement of delivery)
i UD/TO ?/AGENT LICENSING OFF/CE APPROVAL: (Not for use by Srrb-Agents)
1 cerfiWkntithlefibove application appears to have been completed correctly, and the applicant
his—igalent documentation toproceed with the recording of this form.
SIGNATURE OFFICE/VFS OPERATOR NUMBER
NAME
RECORDING. NUMBEV:
X
RECORD/NG OFFICE
This form has been recorded in the county records.
TD -42' 129 MANUF HOME APPLIR/7/931OR Pipe 1 of 2
COUNTY
VO
DATE