2006, 01-19 Title EliminationAFTER RECORDING MAIL TO:
First American Title
40 E. Spokane Falls Blvd.
Spokane, WA 99201
Filed for Record at Request of:
First American Title Insurance Company
First American Title
Insurance Company
rTAT,_c"Y,p.�St�tN�tLkM MANUFACTURED HOME
PLEASE CHECK ONE
��� �t""�""
IKEnsinc APPLICATION
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.
X
7
❑
TITLE ELIMINATION
TRANSFER IN LOCATION
REMOVAL FROM REAL PROPERTY
(RCW 46.12.210)
1
MANUFACTURED HOME
TPO/PLATE NUMBER
%81343
YEAR
1984
MAKE
Sherw
LENGTH/WIDTH (FEET)
60 y 24T
VEHICLE IDENTIFICATION NUMBER (VIN)
AB7SC2183OR
2
LAND LEGAL DESCRIPTION ON PAGE 2
MANUFACTURED HOME WILL BE
X AFFIXED REMOVED
REAL PROPERTY TAX PARCEL NUMBER
45203.1002
LOT
2
BLOCK
10
PLAT NAME OR SECTION/TOWNSHIP/RANGE
Siesta Mobile Park First Addition//
OUARTER/OUARTER SECTION
3
GRANTOR(S) REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE
COUNTY NUMBER
0144
NUMBER OF REGISTERED OWNERS
1
NUMBER OF LEGAL OWNERS
1
NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
Elmer D. Tenhulzen -1--C-- Al 1-1 U G: I7_,_2S 0
NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
Nancy N. Tenhulzen -re-n1 )4 u ma t' 60 _4 /-
ADDRESS CITY STATE ZIP CODE
1224 South Siesta Drive, Spokane Valley, WA 99206
NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
Same as Registered Owner
NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
Same as Registered Owner
ADDRESS CITY STATE ZIP CODE
�, Ii4RANTEE
Pe(5V41ICLE AND OLEMNLY TTHIS INFORMATION IS CCURATEEST UNDER PENALTY OF RY THAT I/WE AM/ARE THE REGISTERED OWNER(S) OF
iritSignature of Registered Owner and Title, IF APPLICABLE _ - ___
4.
4Suture of Additional Reg, Owner and Title, IF APPLICABLE - ,f /L - 4 .� , 1I -
• 5 00TARY SEAL OR STAMP I9 NOTARIZATION/CERTIFICATION F • R REGIS r RED OWNER(S) SIG TURE
I.5- \,�%O `, _ I State of Washington Signed or attest
1 -.
i 0.1.1\UN I County of pt] before me • b
4/11
a by Elmer D. Tenhulzen Signatu - r� \� r.
ir
4it n
PRINT NAME OF REGISTERED OWNER OTARY el' • GENT 11
y 5 by Nancy N. Tenhulzen_ .. I At .
�AS 1 C) - PRINT NAME OF REGISTERED OWNER P' TED NAOF NOTARY
"'r� I County/Office No. OR l
1. • I Title Notary AND Dealer No. OR t
iI
6, I DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Date
4
1
fit COMPANY CERTIFICATION
I certify tha�f!Rglegal description of the land and ownership is true and correct per the real property records.
NAME (TYPED OR PRINTED) TITLE COMPANY/PHONE NUMBER
Sherry Stolz, First American Title Insurance Company (509)838-5281
SIGNATURE/POSITION DATE
Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs.
5
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' P^ERM OFFICE/PHONE,#
BLDG PERMIT #
SIGNAIUR OSITI1011s1(----111
✓ - fl ! ,�
'( r-., ,,_ DATE
it' �, b`11 t ,�..---,c, t_01, l— \c\ --OL,
�0�420-7Z9 F H ME APPL (R/2/0 R (W)Pag
First American Title File No. 4251-683325 (SMG)
MANUFACTURED HOME — FROM SECTION 1
TPO/PLATE NUMBER
%81343
YEAR
1984
MAKE
Sherw
LENGTH/WIDTH (FEET)
60 X 24T
VEHICLE IDENTIFICATION NUMBER (VIN)
AB7SC2183OR
6 SIGNATURE OF LEGAL OWNER
SIGNATURE OF LEGAL OWNER INDICATES CONSENT FOR ELIMINATION
Signature of Legal Owner and Title, IF APPLICABLE
Signature of Additional Legal Owner and Title, IF APPLICABLE
OF TITL J/REMO AL -R• M REAL ' ' OPERTY.
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;
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'''‘i'%.47
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. 0:44 $
/4
-"I' III `�'
State of Washington
1
by Same
NOTARIZATION/CERTIFICATION FOR LEGAL • WNER(S) SIGNATU • E
r. / _
Signed or attested Oa_0
County of Spokane before me on lL
12
1
Signatur.
as Registered Owner
I PRINT NAME OF LEGAL OWNER OR GENT
I
1 by Same as Registered Owner Cr_t (tet G ftuc d
1 PRINT NAME OF LEGAL OWNER PRINTED
1
Title Notary AND
NAME OF NOTARY
County/Office No. OR
No. OR
Notary Expiration Date
( I
1TitleDealer
• DEALERSHIP POSITION/AGENT/NOTARY
7 LAND DESCRIPTION (A legal description of the land can be obtained from the local County Assessor's Office)
LOT 2, BLOCK 10, SIESTA MOBILE PARK FIRST ADDITION, ACCORDING TO PLAT RECORDED IN VOLUME 8 OF PLATS, PAGE
23, IN THE CITY OF SPOKANE VALLEY, SPOKANE COUNTY, WASHINGTON.
8 DEALER'S REPORT OF SALE
I CERTIFY THAT THIS INFORMATION IS CORRECT. THE VEHICLE IS CLEAR 0 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
1
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 OFFICE/VFS OPERATOR NUMBER
SIGNATURE
DATE
10 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 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.
TOTAL FEES & TAX
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 ofprovid/ng 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
First American rt%:
Insurance Company
11. 411..1 k. ,,tri of 1441su.4 al
8708200286
C .ton Nees
171 Pines Rd,
Spokane, Wa. 9920¢,
I .. .off
RMWAMOWANTMM
a �a 4 CB r H 18,
& Pr'r r k
Statutory Warranty Deed
I 11,•: t.UA\ 1111( , JEAN 1.. GOMNESS, a single person,
1 $111 .u.,d1.n111.1lI1n..4
p;; •
M
it 1
TER DOLLARS ($10.00) and other valuable consideration
11111:114.1 41.111. 11,11,111' .1111 N *411,11.1. 1..
ELMER D. TENHULZEN, a single person,
14.e LdL.Nslug 111 +11111111 11' 111•..1411. .'111111111 1+'61 1 01111 1,1
Spokane
, 1,110 t.1 N ,1.41111;'? $1
Lot 2. Block 10, Siesta Mobile Park First Addition, according to
plat recorded in Volume 8 of Plats, Page 23 in Spokane County.
Washington.
Together with one 1984 Sherwood 6/24T mobile home. Serial
number AB7SC2183OR situated on the above described real property.
SUBJECT TO:
Restrictive covenants, easements and encumbrances of
record.
tarns lax Paid on 8700011444
)ala Ant. Pd l'ca.3
OE "SKIP" CHILSERG
Styli( ,M County Tran.
1lditvl , Aug i I 14
/ r
.fenn L. Gomness
Cama Tax Patd on 8700011445
Sala Amit. Pd. /S/.fio
DE "SKIP" CHILSERG
Spok. County Treat
A
.1187
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u
N.11 ,, Spokane i 1 11 \ Iet
1 a. 11 . 119, p.....n.d6 ,,pp. 9m.' h.
Jean 1.. Grimness
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', rr, 1,l; d Ihr *11114,11 91,11 InreM..lu4 111.It1111n911 .U..,
a:l b,.*11, dowel 11141 she .)yard Ilii ..un.
her 111•. rnd m',,111111, 101 MIA d..;1
1 ,1 11., ....•• rnd pot pour. thereon meutnrn.,1
.111114. m. Meted' mot ..11.1111 .reit Un -
1 , r' deo eA..._. �>,y
re.
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11.11 l** Al $11
m fl
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t t <' ity` fit.•
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trope. int h. .•1
the 4orpe,rrtnn114.44 ,t1.,„ted Ih. forej.rnpt 4n.Mor,ent• mal at kteesdedgrd 11.. +ant •1.,111.
ment to lee the free and ,, dtmury .t t and deed ..f .a.d . ogr.,reit eon, l.., t he• .,....r4 p,. ,p•
therein mentn.ned and on oath .rated that
auth.4rlr.dtotam eetethe maid m.tntm.ntand item thr 4r419fl...d1eihr4.npinme.e42,1.,.,,1
4.,rpnlral.In
hand and ..'Voris' eras Met t.. .41..,4 the da. .1,4 •rat 444.1 4111• "0.411:.
.1” o141,
\:.Ire I',,hIo en and fon the Matt •.1 Ne•h.npoa. creole% :rt