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2007, 10-28 Title EliminationRETURN ADDRESS C. Jon Nees, Attorney 12911 East Sprague Avenue Spokane Valley, WA 99216 707-4130 dWASHINGTON Anyone of a STATE DEPARTMENT OF Manufactured Home LICENSING Application who knowingly makes a false statement of a material fact is guilty felony, and upon conviction may be punished by a fine, imprisonment, [TITLE REMOVAL (RCW x*a.rx:�•rl� ��y ELIMINATION IN LOCATION FROM REAL PROPERTY 46.12.210) •TRANSFER • or both. 1 MANUFACTURED HOME TPO / PLATE NUMBER YEAR 1971 MAKE Royla LENGTHANIDTH(FEET) 53T X 24 VEHICLE IDENTIFICATION NUMBER (VIN) S4468 2 LAND LEGAL DESCRIPTION ON PAGE MANUFACTURED HOME WILL BE [AFFIXED REAL PROPERTY TAX PARCEL NUMBER 55082.1111 • REMOVED LOT 2 BLOCK 10 PLAT NAME OR SECTION/TOWNSHIP/RANGE Barker Road Mobile Home 1st 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 Mark A. Gunderson OWNER DOL CUSTOMER ACCOUNT NUMBER (. UN lJ i:" H A :21d.=2)ci OWNER DOL CUSTOMER ACCOUNT NUMBER NAME OF ADDITIONAL REGISTERED ADDRESS CITY STATE ZIP CODE 19110 E. Montgomery Drive Spokane Valley WA 99016 NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER CLS Mortgage NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE 12904 E. Nora Spokane WA 99216 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 REGISTERED OWNER(S) OF THIS <ti!'' APPLICABLE}f j �" " APPLICABLE NOTARY SEAL OR STAMP I :% !._.. "\`\, t t t 1I► 1 State �:� �` %%�„Taq ►►/�/ I Z. S S`Q h Y '; ;by r.0 0 V r y z ; 40. wrj i sVince ` Z -by / S J P - v _ CO } ' pili Q / %%%%%%%%%%%%%%%%%%%%%I Title 11, `4TA1 E I NOTARIZATION/CERTIFICATION of Washington Countyyof Mark A. FOR REGISTERED Signed Spokane or attested g before), OWNER(S) SIGNATURE `l. - on Qi 2s,.. 2, 2 00 % Gunderson Signature s-�' PRINT NAME OF REGISTERED OWNER N• A. OR AGENT PRINT NAME OF REGISTERED OWNER PRINTED Notary NAME OF County/Office AND: Notary NOTARY No. OR /zU/t I Dealer No. OR DEALERSHIP POSITION/AGENT/NOTARY Expiration Date 4 `� TITLEbANWYERTIFICATION 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: ® 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) BLDG PERMIT OFFICE/PHONE # BLDG PERMIT # 2186 SIGNATURE / POSITION DATE TD -420-729 (R/6/06) W Page 1 of 2 Spokane Valley, WA 99216 707-4130 diWASHINGTON STATE DEPARTMENT Of Manufactured Home , LICENSING Application Anyone who knowingly makes a false statement of a material fact is guilty of a felony, and upon conviction may be punished by a fine, imprisonment, [TITLE REMOVAL (RCW 'L ASE C CK ONE ELIMINATION IN LOCATION FROM REAL PROPERTY 46.12.210) ■TRANSFER • or both. 1 MANUFACTURED HOME TPO / PLATE NUMBER YEAR 1971 MAKE Royla LENGTH/WIDTH(FEET) 53T X 24 VEHICLE IDENTIFICATION NUMBER (VIN) S4468 2 LAND LEGAL DESCRIPTION ON PAGE MANUFACTURED HOME WILL BE [AFFIXED REAL PROPERTY TAX PARCEL NUMBER 55082.1111 • REMOVED LOT 2 BLOCK 10 PLAT NAME OR SECTION/TOWNSHIP/RANGE Barker Road Mobile Home 1st 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 Mark A. Gunderson Cr4I, t> Ii )-1_,/ ll NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE 19110 E. Montgomery Drive Spokane Valley WA 99016 NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER CLS Mortgage NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE 12904 E. Nora Spokane WA 99216 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 REGISTERED APPLICABLR,/ !h J �" OWNER(S) OF THIS " APPLICABLE NOTARY SEAL OR STAMP I „, !GC�J 'Is fs I State w�r%%%%n q y// I Sf�Y rD I by i +- v ' S to 11; ,�,,0 OA;104 CO 1 /// nus„"`'% �� -7 I Title `, •TATE ©r.' I NOTARIZATION/CERTIFICATION of Washington County of Mark A. FOR REGISTERED Signed Spokane or before) OWNER(S) SIGNATURE attested on Qi'C 2 , 2007 Gunderson Signature PRINT NAME OF REGISTERED OWNER N• A- OR AGENT PRINT NAME OF REGISTERED OWNER PRINTED Notary NAME OF County/Office AND: Notary NOTARY No. OR Dealer No. OR 1/20/1 1 DEALERSHIP POSITION/AGENTiNOTARY Expiration Date 4 TITLPbttiMMI�ERTIFICATION 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. 5 BUILDING PERMIT OFFICE CERTIFICATION I certify that: RI the manufactured home has been affixed to the real property as described. in a building permit has been issued for this purpose and the attachment will be inspected upon completion. NAME TYPED OR PRINTF BLDG PERMIT OFFICE/PHONE # BLDG PERMIT #