1992, 04-27 Title Elimination•STATE OF WASHINGTON
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MANUFACTURED HOfMEE TITLE TO REAL PROPERTY) APPLICATION
Manufactured Home:
Year / q � Make
r✓ Width o `T" / Length /, C9
Vehicle Identification Number 7 7 /
Registered Owners:
Names t) A) 41c1 tI/1, Gt.Ik f Sbes /? LI); 1 'Signatures
/4 -‘,
Legal Owners: 1 _ / I "
Names ,iA1d /14. 4r.1� /
1 4. SA N h t2A ►P_ ti K ' Signatures a -�� 6d—€.4
'Signatures of owners indicate termination of interest in the manufactured home through title provided by chapter 46.12
RCW and indicate intent to perfect interest in the manufactured home as real property with the land he!sheithe'; own
and to which it: isiis being affixed.
Land To Which Manufactured Home Is/Is Being Affixed:
irk HCG, ,Jo. 1461g3, 5.70 ' LOC°K t� o9 Na n�'�rQ/11's Add fc /IcttCh/NScsly,
Property Tax Parcel Number loft ^/
etcoR ;A1 -Fo pL PecoP..ciC�cf iAS �'�tLOT) e"s')10f PLAf5 p'�ye t ;'
,Q a
GL'/../ -c, ,
Legal Description:
Owners:
Names
"Signatures p-
"Signatures of owners indicate consent to have the manufactured home added to the real property listed above.
Building Permit Office Certification:
I certify that the manufactured home has been affixed to the real property as described above and/or building permit
number % VI/ 2.3 has been issued for the purpose of affixing the manufactured home to the land and will be
inspected upon cgmpletion. SPOKANE COUNTY
BUILDING & SAFETY
NAME
County Auditor/Agent Licensing Office Approval: (Not for use by subagents)
I certify that the above application appears to have been completed correctly, and that the applicant has sufficient
documentation to proceed with the recording of this form.
.
SIGNAT
RE
BLDG. PERMIT OFFICE
r- a7- �d
DATE
Y.SG-3G7s—
PMCNE vt.meER
N:.ME
Recording Office of County in which Real Property is Located:
S1GNA T URE
OFFICE,CAAP OPERATOR NUMBER
I certify that this form has been recorded in the county records.
CCUNTY DATE PECCFOI:.0 NUVSER
NAME SIGNATURE q
Note: Every person who falsifies or intentionally omits material information required in an affidavit is guilty of a gross
misdemeanor punishable in accordance with RCW 9A.20.021.
see instructions on back page
TD -420.730 MFG HOME TITLE ELIM IN.11901 Page 1 al 2