2007, 01-05 Title EliminationRETURN ADDRESS
OMNI CLOSING SERVICES
708 North Argonne Rd, Ste 11
Spokane Valley, VVA 99212
File No. 6-013
���STATI: C?F ri'A:il i1NG'iO:Y
°?°''" °nr
icEnsinc
MANUFACTURED HOME
APPLICATION
a false statement of a material fact Is
may be punished by a fine, imprisonment,
Axa°�y'��1����
TITLE ELIMINATION
TRANSFER IN LOCATION
REMOVAL FROM REAL PROPERTY
(RCW 46.12.210)
l
guilty
or both.
Anyone who knowingly makes
of a felony, and upon conviction
1 MANUFACTURED HOME
TPO / PLATE NUMBER
YEAR
2005
MAKE
Golden
LENGTH/WIDTH(FEET)
48 X 27
VEHICLE IDENTIFICATION NUMBER (VIN)
z,B029312OR
2 LAND West LEGAL DESCRIPTION ON PAGE
2
REAL PROPERTY TAX PARCEL NUMBER
MANUFACTURED HOME WILL BE Nj AFFIXED LI REMOVED 55191.0428
LOT
Tract "B"
BLOCK
PLAT NAME OR SECTION/TOWNSHIP/RANGE
Short Plat No. SP -1054-96
QUARTER/QUARTER SECTION
3 GRANTOR(S) REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE
COUNTY NUMBER
Spokane
NUMBER OF REGISTERED OWNERS
2
NUMBER OF LEGAL OWNERS
1
NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
David Routh ROUTHDL521 CF
NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
Dorothy Routh ROUTHDJ5 0 6 LN
ADDRESS CITY STATE ZIP CODE
18214 East Sprague Avenue Spokane Valley WA 99016
NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
Home Boys
NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
ADDRESS CITY STATE ZIP CODE
14525 North Newport Highway Mead WA 99021
GRANTEE
NAME
David Routh and Dorothy Routh ___
1 DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY
VEHICLE AND THIS INFORMATION IS ACCURATE:
Signature of Registered Owner and Title, IF
Signature of AdditionaiRe istered Owner and Title, IF
THAT I / WE 14E REGISTERED
C
i
APPLICABL•If
0 ' R(S)
OF THIS
��%
APPLICABLE ' �r.
% - - '--
+ARY
eD
4
toP4
44
SE/ R CTAMP
n
O=/
c m —1 rn
y o
—4I Z r v �•
rn=Cmc
"a Z c
co-,—ri r— m
N Q
*
,
;
>
>
State
by
by
Title
NOTARIZATION/CERTIFI
of Washington
County of
David Routh
'• TION FOR REGIS
S pokane
ERED OWNER(S)
Signed or attested
before
SIGNATURE
me on 1/27/06
Signat
(` J it,',-r-.�.,
PRINT NAME OF REGISTERED OWNER OTARY OR AGENT
Dorothy Routh Sheila M. Reimer
PRINT NAME OF REGISTERED OWNER PRINTED
Notary Public
NAME OF
AND:
Notary
NOTARY
-pealeFPle6R ,8/1 5/08
T/NOTARY
Expiration Date
4 T
TIFICATION
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.
5 BUILDING PERMIT OFFICE CERTIFICATION
I Certify that ID the manufactured home has been affixed to the real property as described.
ID 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 #
BLDG PERMIT #
SIGNATU / POSITION �, DATE
C( t? 1 1 , �Cni _A''' CL �-: 1- "`DA7:4-1
TO -420=129 ANUF-HOME A L (R/2/02)OR (W )Page 1 of 2