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1995, 09-12 Title Eliminationa -Sri%" SO/ .5/7- OF WASHINGTON D p rtment of ElDepartment - MANUFACTURED HOME 110EBSIflG APPLICATION RECORDER'S CLOCK FILED AT THE REQUEST OF: NAME ADDRESS Please X check one TITLE ELIMINATION (Complete all but section 3, below) TRANSFER IN LOCATION (Complete ALL sections below) REMOVAL FROM REAL PROPERTY (Complete all but section 4, below) 1 MANUFACTURED HOME TPO/PLATE NUMBER YEAR 1986 MAKi1ODUL INE ARDMORE WIDTH/LENGTH 40'x24' VEHICLE IDENTIFICATION NUMBER (VIN) 97970 2 LAND Attach legal description land. It be from County a copy of the of your can Assessor's office or it may be typed or printed on an Additional AFFIXED obtained your Attachment Form (TD -420-732). REMOVED PROPERTY TAX PARCEL NUMBER 55071 .0601 Manufactured home will be IX 3 TITLE COMPANY CERTIFICATION Icerti' LOT 1, BLOCK 4, RIVERVIEW MOBILE HOME SUBDIVISION, AS PER PLAT RECORDED IN NAME VOLUME 9 OF PLATS, PAGE 29' I IX Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs. 4 BUILDING PERMIT OFFICE CERTIFICATION I certify that the manufactured home has been affixed to the real property as described, or a building per it has be n issued for this purpose and the attachment will be inspected upon completion. BLDG PERMIT # 0 ( NAM ` j fiJ 1L1L liiitI�',({L tilt, SIGNATURE/TITLE X SPOKANE COUNTY AND PLANNINQ PIG A BLDG PERMIIT1OFFICE/PHHONNE # r ti J (SO�I)14Yr;..`)l0 ,� DATE 6 il I (q 5 OWNER INFORMATIO DIVISION OI- BUILD FEES COUNTY# INC UNINC fl X # REGISTERED OWNERS 2 # LEGAL OWNERS 1 Provide the Washington Driver's License or I.D. card number (PIC) for each owner: FILING FEE NAME OF FIRST OWNER E LEROY C EMERSON /11£n S LC -75-5-' j APPLICATION G NAME OF SECOND OWNER s EDITH C EMERSON [Agit S F ‹ —Mico MOBILE HOME FEES E ADDRESS OF OWNER E 2925 N RIVISTA DR R --OR-- if the owner is a business, ELIMINATION 0 CITY OTIS ORCHARDS STATE WA ZIP CODE 99037 provide the Unified Business Identifier (UBI), found on the business Registration & Licenses USE TAX NAME OF FIRST LEGAL OWNER' L I WASHINGTON MUTUAL BANK Document. 578049326-7 SUB -AGENT FEES e MAILING ADDRESS OF FIRST LEGAL OWNER N N 12005 E SPRAGUE AVE, 2ND FLOOR More than two owners or one lienholder? Please use attachment TOTAL FEES & TAX LCITY STATE ZIP CODE form(s) #TD -420-732. $ I D SPOKANE E WA 99206 DEALER'S REPORT OF SALE R 'SIGNATURE OF LEGAL OWNER IN ATES CONSENT FO FROM REAL PROPERTY: X „^ ; . �� OF TITLE/REMOVAL J I certify that this information is correct. The vehicle is clear of encumbrances except as shown. Anyone who knowingly makes a false statement of a material fa upon conviction may be punished by a fine of up to $5,000 and/or t is guilty of a felony, and 10 years imprisonment WA DLR NO DATE OF SALE PURCHASE PRICE $ I (RCW 46.12.210). I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY LAW THAT I/WE ARE THE REGISTEREDOWNE• HICLE AND THIS INFORMA- TION I. A) CUy-.T� - gnature . ike(( SF MM0''►►Nf�•11 DEALER NAME TAX JURISDICTION/TAX RATE DE_ _A�ERyUTHORIZED SIGNATURE X - ,ice .,. _; l; 5� lE or • X ��� I,'��,L )w�07��J�) X . U • ♦r USE TAX EXEMPT Sale to a Certified Tribal member on the reservation (attach notarized statement of delivery) • • NOTARY O LICENSE AGEN 8 NU , ' ��t`/Cf1J TO AND SWORN BE ORE " THIS Residing in (County) f,��� - • T c� X ---?--44- . '` •' ` I DAY OF . - ' kt'g_ /,__ COUNTY AUDITOR/A • 1 w II,�`` APPROVAL: (Not for use by Sub -Agents) I. certify that the above app i. , A k4* . ave been completed correctly, and the applicant has sufficient documentation to proceed with the recording of thi - . NAME SIGNATURE 1 X OFFICENFS OPERATOR NUMBER DATE TD-420-729'MANUF HOME APPL (R/2/94)M Page 1 of 2