2007, 09-27 Title EliminationFMYAPP
AFTER RECORDING MAIL TO:
Pacific Northwest Title
120 W. Catlado, 2nd Floor
Spokane, WA 99201
Filed for Record at Request Of: Space above this line for Recorders use only
Pacific Northwest Title Company of Spokane, Inc.
MANUFACTURED HOME PLEASE CHECK ONE
j� #"1AYKCVWA047dNOC'TON
r ."W'f APPLICATION x TITLE ELIMINATION
&V1j110EnSinGTRANSFER IN LOCATION
Anyone who knowingly makes a false statement of a material fact is guilty ❑ REMOVAL FROM REAL PROPERTY
of a felony, and upon conviction may be punished by a fine im risonmen or both. RCW 46.12.210
MANUFACTURED HOME
TPO/PLATE NUMBER
YEAR
MAKE
LENGTH/WIDTH(FEET)
VEHICLE IDENTIFICATION NUMBER (VIN)
1997
Spring
56 X 28
I ORE326236/ORE326237
LAND LEGAL DESCRIPTION ON PAGE 2
REAL PROPERTY TAX PARCEL NUMBER
MANUFACTURED HOME WILL BE Fx AFFIXED ❑ REMOVED
55082.1216
LOT
BLOCK
PLAT NAME OR SECTION/TOWNSHIP/RANGEOUARTER/OUARTER
SECTION
//
GRANTORS REGISTERED/ LEGAL OWNERS ADDITIONAL NAMES ON PAGE
COUNTY NUMBER
NUMBER OF REGISTERED OWNERS
NUMBER OF LEGAL OWNERS
0146
1
1
NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
Valerie A. McNeill
NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
ADDRESS 1911 C OOI�<►1s. Vr+ �l STATE ZIP CODE
27 E OZ
NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
Countrywide Home Loans
NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
ADDRESS CITY STATE ZIP CODE
6007 N. Division, Spokane, WA 99208
GRANTEE
NAME
I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT I/WE AM/ARE THE REGISTERED OWNS ) OF
THIS VEHICLE AND THIS INFORMATION IS ACCURATE: -
Signature of Registered Owner and Title, IF APPLICABLE
Signature of Additional Registered Owner and Title, IF APPLICABLE
NOTARY SEAL OR STAMP I NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER(S) SIGNATURE
State of Washington Signed or atles d L -7
Spokane `� d
County of before m n ��
Notary Public
State of Washington i y Valerie A. McNeill Sig e
ISSA D RACZYKOWSKI I PRINT NAME OF REGISTERED OWNER NOTAR AGENT
Iniment Expires May 31, 201 V by -
I PRINT NAME OF REGISTERED OWNER PRINTED NAME OF NOTARY
Notary Nota County/Office No. OR {J�/�� /
IT le AND Dealer No. OR
1 DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Date
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
Virginia Clemens, Pacific Northwest Title Company of Spokane, (509)744-3434
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
❑ the manufactured home has been affixed to the real property as described.
I certify that:
❑ 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 #
x�r 60 SK.Cr
v� 0a 2>11
SIGNATU E/POS ON [; DATE
TD -420-7Q MANUF HOME AP9L (R/Z/02)OR (W)Page of
First American Title File No. SPO -1046311 (ADR)
MANUFACTURED HOME — FROM SECTION 1
TPO/PLATE NUMBER
YEAR
MAKE
(FEEr)
VEHICLE IDENTIFICATION NUMBER (VIN)
1997
Spring
rLENGTH/WIDTH
6 X 28
ORE326236/ORE326237
SIGNATURE OF LEGAL OWNER
SIGNATURE OF LEGAL OWNER INDICATES CONSENT FOR ELIMINATION OF TITLE OVAL FROM REAL PROPERTY.
Signature of Legal Owner and Title, IF APPLICABLE
Signature of Additional Legal Owner and Title, IF APPLICABLE
NOTARY SEAL OR STAMP I NOTARIZATION/CERTIFICATION FOR LEGAL OWNER(S) SIGNATURE
Signed or attested
I State of Washington g � 2 c4 / O�
County of Spokane before me onNotary
Publicsignatur
oun ide Home LoansState
o1 WashingtonRINT NAME OF LEGAL OWNER NOTARY OR AGENT
]2611b
LISSA D RACZYKOWSKI/4�ntment
May 31.RINT
Expires
NAME OF LEGAL OWNER PRINTED NAME OF NOTARY
County/Office No. OR T-- 1, �,
TRIe Notary AND Dealer No. OR / .,
DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Date
LAND DESCRIPTION (A legal description of the land can be obtained from the local County Assessor's Office)
LOT 16, BLOCK 11, BARKER ROAD MOBILE HOMES FIRST ADDITION, AS PER PLAT RECORDED IN VOLUME 9 OF PLATS, PAGE
70;
SITUATE IN THE CITY OF SPOKANE VALLEY, COUNTY OF SPOKANE, STATE OF WASHINGTON.
DEALER'S REPORT OF SALE
I CERTIFY THAT THIS INFORMATION IS CORRECT. THE VEHICLE IS CLEAR O ENCUMBRANCES EXCEPT AS SHOWN. ANY
REQUIRED SALES TAX HAS BEEN COLLECTED.
DEALER NAME (TYPED OR PRINTED)
WA DEALER NUMBER
DATE OF SALE
PURCHASE PRICE
TAX JURISDICTION/TAX RATE
DEALER'S AUTHORIZED SIGNATURE
USE TAX EXEMPT Sale to a Certified Tribal member on the reservation (attach notarized statement of delivery)
COUNTY AUDITOR/AGENT LICENSING OFFICE APPROVAL: (Not for use by Subagents)
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.
NAME (TYPED OR PRINTED)
COUNTY OFFICENFS OPERATOR NUMBER
SIGNATURE
DATE
TITLE FEES
FILING FEE
APPLICATION
MOBILE HOME FEE
ELIMINATION FEE
USE TAX
SUBAGENT FEES
TOTAL FEES & TAX
IMPORTANT: Once the application has been approved by the County Auditor/Vehicle Licensing
Office, take your application form to the county Recording Office. Retain proof of the
recording fees paid. If the Recording Office retains your original application form,
obtain a certified copy of the recorded form.
APPLICANTS: Once recorded, you must return to a Vehicle Licensing Office to file the
Manufactured Home Application, paying all required fees. Vehicle licensing
subagents charge a service fee.
For full instructions on completing this form for title Elimination, Removal from Real Property or
Transfer in Location, see form TD -420-730, Manufactured Home Application Instructions.
The Department of Licensing has a policy of providing equal access to its services If
you need special accommodation, please call (360) 902-3600 or TDD (360) 664-8885.
TD -420-729 MANUF HOME APPL (R/2/02)OR (W) Page of