2008, 05-27 Title EliminationRETURN ADDRESS
Manufactured Home �a�rx�yry:/xN.���vi
C•!WASHINGTON STATE DEPARTMENT OF [TITLE ELIMINATION
. LICENSING Application ■ TRANSFER IN LOCATION
II
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, imprisonment, or both. (RCW 46.12.210)
D MANUFACTURED HOME
TPO / PLATE NUMBER
YEAR
2007
MAKE
Co. Cottage
LENGTH/WIDTH(FEET)
27 X 56
VEHICLE IDENTIFICATION NUMBER (VIN)
VMHI280475088AB
A LAND LEGAL DESCRIPTION ON PAGE
MANUFACTURED HOME WILL BE (AFFIXED • REMOVED
REAL PROPERTY TAX PARCEL NUMBER
55071.0603G/55071.0603H
LOT
3
BLOCK
4
PLAT NAME OR SECTION/TOWNSHIP/RANGE
VOL. 9 OF PLATS, PAGE29
OUARTER/OUARTER SECTION
3
GRANTOR(S) REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE
COUNTY NUMBER
NUMBER OF REGISTERED OWNERS
NUMBER OF LEGAL OWNERS
NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
CATHERINE R. SHIELDS
NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
ADDRESS CITY STATE ZIP CODE
2913 N. RIVISTA DR. SPOKANE VALLEY WA 99027
NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
IORIZON CREDIT UNION
NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
A DESS , CITY STATE ZIP CODE
.. C )S',.% / y / L45- , ,x10 ed,1. - LI I( L\, G.1 A c r' 2 /
GRANTEE
NAME
I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT 1 / WE AM/ARE THE REGISTERED OWNER(S) 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
NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER(S) SIGNATURE
State of Washington Signed or attested
County of before me on
by Signature
PRINT NAME OF REGISTERED OWNER NOTARY OR AGENT
by
PRINT NAME OF REGISTERED OWNER PRINTED NAME OF NOTARY
County/Office No. OR
Title AND: Dealer No. OR
DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Date
0 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.
0 BUILDING PERMIT OFFICE CERTIFICATION
I Certify that: ® the manufactured home has been affixed to the real property as described.
® 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 #
- .C(\ \1IU"\ 509- la2?
k6 '0�
BLDG PERMIT M
7_
%-- c 10
SIGMA RE / PO TION DATE
C LCi Uk./4" 'V)) I
ct--{ I 1� L(-;--. I-IV1..1 __ , S
MANUFACTURED HOME - FROM SECTION 1
TPO / PLATE NUMBER
YEAR
2007
MAKE
Co. Cottage
LENGTH/WIDTH(FEET)
27 X 56
VEHICLE IDENTIFICATION NUMBER (VIN)
VMHI280475088AB
6
SIGNATURE OF LEGAL OWNER
SIGNATURE OF LEGAL OWNER INDICATES CONSENT FOR ELIMINATION OF TITLE / REMOVAL FROM REAL PROPERTY.
Signature Legal Owner and Title, IF APPLICABLE URIZUN CREDIT NION
of I%N
Signature of Additional Legal Owner and Title, IF APPLICABLE le es' Le....-------"
N`\ v`OEM gt/.It��j�// 1 NOTARIZATION/G`ERTIFICATION FOR LEGAL OWNER(S) SIGNATURE
�\ `'•',..•• ^•... 0 /i� State of Washington 4� Signed or attested , i ti
1=:;\on xl? ''•.. 'Q21 County of i.0 -\lt_ ALL, before me on J
4i'
Cr y
1
` e
` d ` `�\� � �,��vt� L L -6,/v Signatur
_= �
—I �-- = PRINT NAME OF LEGAL OWNER NOTARY OR AGENT /
Ptj'r�\�v.o,.•�`By -r'2_02 (� Lctr�"zi/L,�p�y6e.,r#1
0,'.
i %, •�'. " `I>).. - PRINT NAME LEGAL OWNER PRINTED NAME OF NOTARY
` County/Otfice No. OR
Title AND: No. // '/� /O
/U Fl ,'`j11\ N.\\`\ I
Notary Exealer
�6 DEALERSHIP P pON/AGENT/NOTARY piration ation Date
Nil/IMO
DLAND DESCRIPTION (A legal description of the land can be obtained from the local County Assessor's Office)
LOT 3, BLOCK 4, RIVERVIEW MOBILE HOME SUBDIVISION AS PER PLAT RECORDED IN VOLUME
9 OF PLATS, PAGE 29;
SITUATE IN THE CITY OF SPOKANE VALLEY, COUNTY OF SPOKANE, STATE OF WASHINGTON
8
DEALER'S REPORT OF SALE
I CERTIFY THAT THIS INFORMATION IS CORRECT. THE VEHICLE IS CLEAR OF ENCUMBRANCES EXCEPT AS SHOWN.
ANY REQUIRED SALES TAX HAS BEEN COLLECTED.
DEALER NAME (TYPED OR PRINTED)
VALLEY QUALITY HOMES
WA DEALER NUMBER
DATE OF SALE
10/2/07
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).
9
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
I1 TITLE FEES
FILING FEE
APPLICATION
MOBILE HOME FEE
ELIMINATION FEE
USE TAX
SUBAGENT FEES
IMPORTANT: Once the application has been approved by the County Auditor / Vehicle
TOTAL FEES 8 TAX
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 cal (360) 902-3600 or TTY (360) 664-8885.
TD -420-729 (R/6/06) W Page 2 of 2