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