2006, 06-30 Title EliminationRETURN ADDRESS
C Jon Nees, AttornPy
323 South Pines Road
Spokane, WA 99206
707-3194
L47/7 STATCOFwASHINc:roN MANUFACTURED HOME
"T�°'`'"`"'°fEJTITLE
IICEI1S1flG APPLICATION ®TRANSFER
Anyone who knowingly makes a false statement of a materlal fact is guilty ®REMOVAL
of a felony, and upon conviction may be punished by a fine, imprisonment, or both. (RCW
rlff�'6/•iiii �'�',iii
ELIMINATION
IN LOCATION
FROM REAL PROPERTY
46.12.210)
1 MANUFACTURED HOME
TPO / PLATE NUMBER
YEAR
1988
MAKE
GOLST
LENGTH/WIDTH(FEET)
66 x 14
VEHICLE IDENTIFICATION NUMBER (VIN)
G8829J18SN10988
2 LAND LEGAL DESCRIPTION ON PAGE
MANUFACTURED HOME WILL BE ® AFFIXED ID REMOVED
REAL PROPERTY TAX PARCEL NUMBER
55064.1004
LOT
4
BLOCK
9
PLAT NAME OR SECTION/TOWNSHIP/RANGE
DONWOOD EAST SUBDIVISION
QUARTER/QUARTER SECTION
3 GRANTOR(S) REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE
COUNTY NUMBER
NUMBER OF REGISTERED OWNERS
1
NUMBER OF LEGAL OWNERS
1
NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
SHERRY L. PETERSON
NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
ADDRESS CITY STATE ZIP CODE
18418 East Liberty Avenue Spokane Valley WA 99216
NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
HORIZON NORTHWEST
NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
ADDRESS CITY STATE ZIP CODE
7600 E. Orchard Avenue #250N Greenwood Village CO 80111
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 REGI ERED OWNER(S) OF THIS
APPLICABLE ' ,-C. Yi1
APPLICABLE E
NOTA EA
`14f�%,� ��� _ I
lit *,,• 581p •, y� _1 State
; # H6 0
IQ- NOTA. 1 I :
�... m t ily
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'�. ' �..` ,,,-..,......',:.0 }1�
;. 0,4 "'. �01County/Office
wASOO, /I�i I Title
�J'�4,,,i//,,,,�
NOTARIZATION/CERTIFICATION
of Washington
County of
Sherryv L.
FOR REGISTERED
Spokane
OWNER(S)
Signed or a
befor
SIGNATURE
ested f „ Z,l��
me on l.Y JU
Peterson Signature
•
/'
��
PRINT NAME'OF REGISTERED OWNER O ARY OR AGENT
�1 1
Jl Y Lt r I L L.t
PRINT NAME OF REGISTERED OWNER PRINTED
Not ar_y
NAME OF
AND:
Notary
NOTARY
No. OR •-7' , �/c'
Dealer No. OR 2 �
DEALERSHIP POSITION/AGENT/NOTARY
Expiration Date
4 TITLE COMPANY CERTIFICATION
1 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.
5 BUILDING PERMIT OFFICE CERTIFICATION
certify that: ID the manufactured home has been affixed to the real property as described.
ID a building permit has been issued for this purpose and the attachment will be inspected upon completion.
NAME (TYPED OR PRINTED) .-7-64' BLDG
1
1 Ai lc
PERMIT OFFICE/PHONE
t
#
I 1
BLDG PERMIT #
87003497
T r
L
SIGNATOR POST N ,_ DATE
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