1995, 12-21 Title Eliminationtai
N
3
E
L.� Dtpartmrnt of
L1JDepaEOrWASH1.GTON MANUFACTURED HOME
IcEnsInc APPLICATION
RECORDER'S CLOCK
FILED NAME AT THE REQUEST OF:
ADDRESS
Please 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)
1 MANUFACTURED HOME
TPO/PLATE NUMBER
YEAR
198y
MAKE ,
G I r3A-As
WIDTH/LENGTH j
l; (4o
VEHICLE IDENTIFICATION NUMBER (VIN)
96,23z
2 LAND
Attach a copy of the legal description of your land. It can be obtained from your County
Assessor's office or it may be typed or ri ted on an Additional Attachment Form (TD -420-732).
PROPERTY TAX PARCEL NUMBER
Li
S) gy . 0 c)-1 b
Manufactured home will be AFFIXED
REMOVED
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 `SI NATURE
I DATE
Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs.
4 BUILDING PERMIT OFFICE CERTIFICATION
1 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 apfitaritAjilricp inspected upon completion.
BLDGPERMIT M
1/6"--/r)J-0
N (
j , L,� 1 ^ �4
SIGNATURE/TITLE
X DIVISION OF BUILDING AND PLANNING
BLDG PERMIT OFFICE/PHONE f j
DA/ - L/ _ &.
5 OWNER INFORMATION
FEES
COUNTY a INC UNIN
11 REGISTERED OWNERS
# LEGAL
Provide the Washington Driver's License or I.D.
card number (PIC) for each owner:
FILING FEE
r1
NAME OF FIRST OWNER \.....,,..)-a..5
R \— 1 - 1 .
E � t� Y'�
p n37p G2-- 4ci / c
#o_Io ,,,, �-', \c ,
APPLICATION
i 1
0 NAME OF SECOND OWNER
S kph t\` v 1.-. • LvCa `:
OA µQt 9 O t Q
D
�'o`t s2160O3'-
MOBILE HOME FEES
�---
E ADDRESS OF OWNER
E
R c \ \a \\
OR if the owner is a business,
ELIMINATION
E96,-1-1 C. J "--\A")-provide
the Unified Business
USE TAX
D CITY
oK2i
ST TE
0 A
ZIP CODE
q9 21g--
Identifier (UBI), found on the
business Registration & Licenses
tl1✓
I
FEES
30V
30
NAME OF FIRST LEGAL OWNER'
-40)n rTh ii • --v C., 5
Document.
SUB -AGENT
I
i
MAILING ADDRESS OF FIRST LEGAL OWNERMore
B3» \j%`\ W�
than two owners or one
lienholder? Please use attachment
TOTAL FEES & TAX
CITY
STATE
ZIP CODE
form(s) #TD -420-732.
's
��a�l�
��
(19 al -a__
DEALER'S REPORT OF SALE
Vc
P
'SIGNATU E OF LEGAL OWN R INDI TES CONSEN F R ELIMI • 4N T LE/REM pyAL�
�
FROM REAL PROPERTY: ��w"
I certify that this Information Is correct. The vehicle Is clear
of encumbrances except as shown
II i4one
pn
.,...•(42Frir✓v
who knowingly makes a false statement of a material :et/guilty of a felony, and
conviction may be punished by a fine of up to $5,000 and/c1 10 years imprisonment
WA DLR NO. DATE OF SALE
PURCHASE PRICE
CW 46.12.210). I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY LAW
IAT I/WE ARE THE REGISTERED OWNERS OF THIS VEHICLE AND THIS INFORMA-
JN IS '. C ' ATE: Owner Sign ture(a) & Title(s):
• ���11�1.��AX
DEALER NAME ,,�=`OR A L. Al**,_ /
f
, l� 4/.%�
JURISDICTION/TAXRATE
-
0-4---...'
t.QN 1l•.74/.
,_E•
DEALER'S AUTHOR D SI61��,1F"C� "T�p •.
9�„`'�
X NOTARY
ay.
:•f /��� � t o
US AX EXJAPT Sale W a Citified Tribal member on
the 4eservak t nota tzs etement of delivery)
NOTAR • •R LICENSE AGENT & NUMBER
a......,..,.....�
UBSCRIBED TO A SWORN BEFORE ME THISS-
1 &\--DAY OF k-, *--1"-T1bt12- 19
�fjiesid ng in (Co
"
,d
?'.'441
via
6
COUNTY AUDITOR/AGENT LICENSI FFICE APPROVAL: (Not for use by Sub-Ag�tt) F ViiAcJ
I certify that the above application appears to have been completed correctly, and ti1612l 91128 as sufficient documentation tc
oceed with the recordin• of this form.
SIGNATURE
OFFICENFS OPERATOR NUMBER
729 MANUF HOME APPL (R/12/94)M Page 1 of 2
X
DATE