1996, 04-24 Title Elimination• 1
Please
X
STATE OF WASHINGTON
De=arrentof MANUFACTURED HOME
IJtEnSII1G 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
1996
MAKE
Kit Sierra
WIDTH/LENGTH
66X26.7
VEHICLE IDENTIFICATION NUMBER (VIN)
2 LAND
Attach a copy of the legal description of land. It can be obtained from CountyY
your
Assessor's office or it may be typed or printed on an Additional
Manufactured home will be AFFIXED
your
Attachment Form (TD -420-732).
REMOVED
Ax NUMBER
• l�'1
r
3 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.
13 BUILDING PERMIT OFFICE CERTIFICATION
I certif that the manufactured home has been affixed to the real property as described, or a building
'ssued for this purpose and the attachment will bg Inspected upon completion.
perm' has be/1WJ32vO
BLDGpERMITi
% 1eD �%�j�
AME •
SIGNATURE/TITLE SPOKANE COUNDGPERMIT
X DIVISION OF BUILDING AND PLANNING
OFFICE/PHONE K
, T /��` ���
DATE
79/9
OWIR INFORMATION
FEE
COUNTY a INC UNI
❑1 Xi2
s REGI
=RED OWNERS
b LEGAL OWNERS
1
Provide the Washington Driver's License or I.D.
card number (PIC) for each owner:
FILING FEE
NAME OF FIRST OWNER
E Cleo K. Allen
4ntiga-a,ss1 .T
APPLICATION
G NAME OF SECOND OWNER
TJame R • Allen
A fo.)ex. 53-1.a6J
MOBILE HOME FEES
I
E ADDRESS OF OWNER
R 16429 E. Main Avenue
E
--OR-- if the owner is a business,
ELIMINATION
0ITY
Spokane
STATE '
WA
ZIP CODE
9 9 21 6
provide the Unified Business
Identifier (UBI), found on the
business Registration & Licenses
USE TAX
NAME OF FIRST LEGAL OWNER'
L Washington Mutual Bank
1
e
Document.
SUB -AGENT FEES
MAILING ADDRESS OF FIRST LEGAL OWNER
H 1201 Third Avenue
o
More than two owners or one
lienholder? Please use attachment
TOTAL FEES & TAX
L CITY
STATE
ZIP CODE
form(s) #TD -420-732.
E Seattle
WA
98101
DEALER'S REPORT OF SALE
R *SIGNATURE OF LEGAL OWNER ATES CONSENT FO 4 TITLE/REMOVAL
FROM REAL PROPERTY: X 1
I certify that this information is correct. The vehicle is clear
of encumbrances except as shown.
Anyone who knowingly makes a false statement of a material fact y a !i .t
upon conviction may be punished by a fine of up to $5,000 an.. fi:----sr
(RCW 46.12.210). I DO SOLEMNLY ATTEST UNDER P QP �� a (•
WA DLR NO.
tert
DATE • SALE
PURCHASE PRICE
/� —
THAT I/WEARE THE REGISTERED OWNERS OFTHIS VeI.• . • HIS IN :
TION ISSACCURATE: Owner/Slgneture(s) & TiUe(s): :p IN
L�Si
'
rr v, amu •
TAX JURISDICTION/TAXTE
Q �+/l,..
O
X / ' Q( �) ��/ /� /% w •
l..�Iu/v /A K n • ��
DE " "S eTHO•I ED : t NATURE
n PUBUC
`, -,e.„,
` `e
X '''.•'' '�, 9� c,
••..31.�..•a�
�O
USE TAX EXEMPT Sale to a Certified Tribal member on
the reservation (attach notarized statement of delivery)
NOTARY"OOR.LICENSE AGENTJ& NUMBER %j
X'S`e'�-Wav'o'C
IO .4O WV6WRl
VI.
I ilwts.•I7i�1�r0
ORN BEFORE ME THIS
191 ..
Residing in (County)
pK...., 1,5,...E
6
COUNTY AUDITOR/AGENT LICENSING OFFICE APPROVAL: (Not for use by Sub -Agents)
I certify that the above application appears to have been completed correctly, and the applicant has sufficient documentation to
proceed with the recording of this form. tiws•„
NAME
SIGNATURE t, 'i
X
l 1 8 FS OPERATOR NUMBER
DATE
ageto