1995, 03-23 State of WA MH App IllDr-art°tn Q/SHf=GTON RECORDER'S CLOCK
IkEflSIflG MANUFACTURED HOME APPLICATION
TITLE OPTIONS
Original 71 TITLE ELIMINATION(Complete all but section 3,below)
Transfer TRANSFER IN LOCATION (Complete ALL sections below)
Duplicate — REMOVAL FROM REAL PROPERTY(Complete all but section 4,below)
Reissue
RECORDED AT
REQUEST OF:
—
1 MANUFACTURED HOME
YEAR : MAKE >; WIDTH/LENGTH '':VEHICLE IDENTIFICATION NUMBER IVINI COLOR s1 COLOR 02
TOP ORBOTTOM OR
988 BRADB 4828 BD6919 (FRONT: IREARCOLOR: _
a LAND
• Attach a copy of the legal description of your land. It can be obtained from your Cou-1ty Assessor's office.
• Land to which the manufactured home is being: AFFIXED REMOVED PROPERTY TAX PARCEL NUMBER
3 TITLE COMPANY CERTIFICATION
I certify that the legal description of the land and ownership are true and correct.
NAME 'a. ' i! TITLE COMPANY/PHONE NUMBER ` -.SIGNATURE 1 DATE
X
NOTE: Application must be finalized with a Licensing Agent within 10 calendar days of the date signed by the Title Company Representative.
4 BUILDING PERMIT OFFICE CERTIFICATION .
I certify that the manufactured home has been affixed to the real property as described, or the BLDG PERMIT s
folio win. bull a in. •ermit has been issued for this purpq,$� t''I ._ ' .-4. d upon completion. S17 003 -19
SIG/TURE/UT 7 ® Il DY PERMIT OfFICEJPHONE NUMBER DATE
N�/ff/ , , . (i/Lti! .1//�.,/i. , .1 , DIVISION OF BUIL I IN�,'� -3)075 k,6 •c 5
OWNER INFORMATION "FEES
g COUNTY I INC UNINC NUMBER OF I NUMBER OF Please provide the Department of Licensing (DOL) FILING FEE
0 141 REGISTERED OWNERS 2 LEGAL OWNERS 1 Client "NUMBER"for each owner:
NAME OF FIRST REGISTERED OWNER I
E HAROLD R. SIDEL c1L,NIiZ,(QIQ, � , 1� APPLICATION
s ,-f IaI� 17
0, NAME OF SECOND REGISTERED OWNER �1
d ANN L. SIDEL .51? 1 DIC11-1411-I1Pli i3 PIs MOBILE HOME FEES
T ADDRESS OF FIRST REGISTERED OWNER This "NUMBER" may be found on
E 14807 ESAT VALLEYWAY
R your Washington Drivers License/ ELIMINATION
E CITY STATE ZIPCODE I.D. Card--OR--if the owner is a
D
SPOKANE WA 99216 business,provide the Unified I
NAME OF FIRST LEGAL OWNER• business identifierlUB1)number. USE TAX
CREATIVE MORTGAGES 1 1 1 I I I I I I 1 I 1
L MAILING ADDRESS OF FIRST LEGAL OWNER SUB-AGENT FEES
a 711 EAST THIRD More than two registered or l
A CITY STATE ZIPCODE one legal owner? . . .
L SPOKANE WA 99202 Please use attachment forms TOTAL FEES &TAX
fiSS(I�G7NGA�TyU,R.E�.,OlF�LLEE�lG7ALL�QWN.k//INDICATES CONSENT(6,,,,,,,,,„
SEFOR
�t - (DATE (TD-420-732)
`ELIMINAY(17N OF TITI:Ii;/XC�T.1,._t „I:2,(?-t .t„......- //5/'2 $ I
Anyone who knowingly makes a false statement of a material fact is guilty DEALER'S REPORT OF SALE PURCHASE PRICE
of a felony,and upon conviction may be punished by a fine of up to$5,000 1•
and/or 10 years imprisonment(RCW 46.12.210).I DO SOLEMNLY ATTEST I certify that this information is til
UNDER PENALTY OF PERJURY LAW THAT I/WE ARE THE REGISTERED correct. The vehicle is clear of TAX JURISDICTION/TAX RATE
OWNERS OF • IS VEHICLE AND THIS INFORMATION IS ACCURATE: encumbrances except as shown.
RegistvrSignsturs(s): ^ (Title)
�/ i
X ' p r� / C � L .DEALER-.NAME .. DATE OF SALEXI PI III Ir ' ��.f.• — WA.DLR NO. CI : DEALER'S.AUTHORIZED.SIGNATURE
N ��
s •. ° .: .1. '4 °"• Subscribed and Sworn to Before Me This Residing in
X ^� � r �/'''�♦�♦AA 1/ [[ USE TAX EXEMPT Sale to Indian on the
e (;I! „ �:9, v,t� �% Da,,ofkidC. 19 fr Spic/",9 &__(..,_ County Reservation(attach notarized statement of delivery)
'* • , :fff C�-IjINTYAUDITOR/AGENT LICENSING OFFICE APPROVAL:(Not for use by Sub-Agents)
N ; pUiatify th- tile above application appears to have been completed correctly, and the applicant
r• • : : • :+. sufficient documentation to proceed with the recording of this form.
4140,r, •....75A�.e• i T
SIGNAURE OFFICENFS OPERATOR NUMBER DATE
o � . •' e�'� X
t►_
j • easgillit►o RECORDING OFFIC
This form has been recorded in t - co t - • . .
RECORDING NUMBER ... ... COUNTY VOLUME/PAGE DATE
TD-420.729 MANUF HOME APPLIR/7/9310R Page 1 of 2