2007, 09-27 Title EliminationRETURN ADDRESS
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razigamiathigal
(]TITLE ELIMINATION
[]TRANSFER IN LOCATION
❑REMOVAL FROM REAL PROPERTY
guilty
or both. (RCW 46.12.210)
•
Anyone
of a
WASNINRTON STATE DEPARTMENT OF Manufactured Home
LICENSING . Application
who knowingly makes a false statement of a material fact is
felony, and upon conviction may be punished by a fine, imprisonment,
El MANUFACTURED HOME
TPO / PLATE NUMBER i YEAR
+064033 11994
MAKE
REDMN
LENGTWWIDTH(FEET)
28 X 42
VEHICLE IDENTIFICATION NUMBER (VIN)
11820280AB
LAND
LEGAL DESCRIPTION ON
PAGE 2
MANUFACTURED HOME WILL BE [AFFIXED 0 REMOVED
REAL PROPERTY TAX PARCEL NUMBER 1
45183.1105
I
LOT ! BLOCK i PLAT NAME OR SECTION/TOWNSHIP/RANGE
5 11820280AB I HOKOM SUBDIVISON
OUARTER/DUARTER SECTION
GRANTOR(S) REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE
COUNTY NUMBER ( NUMBER OF REGISTERED OWNERS
12
NUMBER OF LEGAL OWNERS
1
DOL CUSTOMER ACCOUNT NUMBER
NAME OF REGISTERED OWNER
JOHN C. ABITZ
NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
KAREN D. ABITZ
ADDRESS CITY STATE ZIP CODE
517 NORTH DICK ROAD SPOKANE VALLEY WA 99212
DOL CUSTOMER ACCOUNT NUMBER
NAME OF LEGAL OWNER
SAME AS REGISTERED
NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
ADDRESS CITY STATE ZIP CODE
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,
THAT I / WE AM/ARE THE REGISTERED OWNER(S) OF THIS
APPLICABLE
IF APPLICABLE
NOTARY SEAL OR STAMP (
State
by
by
Title
NOTARIZATION/CERTIFICATION
of Washington
County of
FOR REGISTERED
Signed
before
OWNER(S) SIGNATURE
or attested
me on
Signature
PRINT NAME OF REGISTERED OWNER
PRINT NAME OF REGISTERED OWNER PRINTED
NAME
AND:
NOTARY OR AGENT
OF NOTARY
County/Office No. OR
Dealer No. OR
DEALERSHIP POSITION/AGENT/NOTARY
Notary Expiration Date
4 TITLE COMPANY 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 PERMIT OFFICE 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),
SIGNATUR /PO ITIONt
BLDG PERMIT OFFICE NE #�
4.
� DG PERMIT #/ 7 i,,
c-. DATE
1t �`"�- C4 �J \, l (�3`r!
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