Loading...
2013, 07-15 Title EliminationRETURN RECORDED DOCUMENT TO: Gustafson & Hogan, P.S. 1500 W. 4th Ave., Suite 408 Spokane, WA 99201 #13-00700 CILWASHINGTON STATE DEPARTMENT OF LICENSING Manufactured Home Application For full instructions on completing this form, see Manufactured Home Application Instructions, form TD -420-730. Please check one: Title Elimination ❑Transfer in Location ❑ Removal from Real Property 1 Manufactured Home TPO/Plate number +168251 Year 1999 Make Kit Length/Width (feet) 63 x 27 Vehicle identification number (VIN) KM1H9976SH244066 2 Land Manufactured home will be !9 Affixed • Removed Real property Tax no. 45072.0210 Legal description on page parcel Lot 4 & N 17' L5 Block 130 Plat name or Section/Township/Range Orchard Avenue Addition Quarter/Quarter section 3 Grantor(s) Registered/Legal Owner(s) — Additional names on page County number No. registered owners 1 No. legal owners 1 Grantee name (if applicable) Name of registered owner Louise Betz Washington driver license or UBI number Name of additional registered owner Washington driver license or UBI number Address (Address, City, State, ZIP code) Name of legal owner Numerica Credit Union Washington driver license or UBI number Name of additional legal owner Washington driver license or UBI number Address (Address, City State, ZIP code) I decl- owner) I - '- + • • of this manufa o perjury under the laws of the state ashington that 1.. r e a : the registered ured home and the foregoing inf tion is true nd-.rrect.�, X % MP 4 �' - "' Signa re of registered o ner an. -, if al).' able X 4 11 o g v o) O Signature of additional registered owner and title, if applicable State of� •County of 5w n trw L N ° Q.mLn < ; , -�i(�I13 Signed or attested before me on ` 4 , Z � ¢ � V I^ ' 1-,z- ' , 3'J y by (--b 4 m cn E cn cn c •'p Pri red own me Print re t� owner name J a a Notary orinted or stamped name Notaryjg ur ki tr.in and f �I1 4 Title Dealer/county office number or notary expiration TD-420-729J4J12)WA Page 1 off 3 Continued on next page factured home TPO/Plate number (from Section 1) 4 Title Company Certification PRINT or TYPE Name of person signing Title company name Position (Area code) Telephone number I certify that the legal description of the land and ownership is true and correct according to the real property records. X Signature Date 5 Building Permit Office Certification ce tify that the manufactured home has been affixed to the real property as described. and the attachment will be inspected upon completion. • a building permit has been issued for this purpose PRINT o�T rE Tame o on si Hing _ - ifvnh jam\ ipfL Buil ing permit office S[V/ Building permit number a a /3sets Position EV • ceeie,i Naj k (Area code) Telephone number (,,/ X WIa Z 1 I I Signature Date • Signature of Legal Owner(s) of Titl or Removal from real pro ! signature ( of legal owner indicates consent Notary Public State of Washington YEVGENIYA A VOROPAY My Appointment Expires Oct 28, 2014 r Elimination /�` ` Signature of legal owner and e, if applble X Signature of additional legal owner and title, if applicable rQS6) 141,14214, County of 5po(AR tot c Notarization/Certification (Seal 1 State of Signed or attested before or stamp) by me on At frIL 1Q Jo ( B , ri uv+ksR4met C.0 by 7eM 7o '(..+G ttt e k not registered owner name Print registeredwwner ryame Print V ; VI A Vo Riopcl Wit S2vf; !f c Notary prinyed�or stamped name and Jp tary J gna�e g /o O/4 Title Dealer/countyooffice number or notary expiration 7 Land Description Legal description of land TD -420-729 (R/4/12)WA Page 2 of 3 Continued on next page PO/Plate number (from Section 1 8 Dealer Report of Sale - Selling dealer complete this section PRINT or TYPE Dealer name Washington dealer number Date of sale Purchase price Tax jurisdiction/Tax rate - Sale to a Certified Tribal member on the reservation (attach notarized statement of delivery). • Sales Tax Exempt I certify that this information is correct. Any required sales tax has been collected. The manufactured home is clear of encumbrances except as shown. X Dealer authorized signature 9 County Auditor/Agent Licensing Office Approval (not for use by subagents) PRINT or TYPE Name County office/VFS operator number I certify that the above application appears documentation to proceed with the recording to be completed correctly, and the applicant has sufficient of this form. X Signature Date 10 Title Fees Filing fee Application Mobile home fee Elimination fee Use tax Subagent fees Total fees and tax $ 0.00 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, or both. RCW 46.12.750 TD -420-729 (R/4/12)WA Page 3 of 3 We are committed to providing equal access to our services. If you need accommodation, please call (360) 902-3600 or TTY (360) 664-0116.