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2007, 01-30 Permit: 06004607 State MH Licensing App RETURN ADDRESS State Wide Escrow 720 N Argonne Ste C - Spokane Valley WA 99212 Manufactured Home PLEASE CHECK ONE diWASHINGTON STATE DEPARTMENT OF [TITLE ELIMINATION LICENSING Application ❑TRANSFER IN LOCATION Anyone who knowingly makes a false statement of a material fact is guilty ❑REMOVAL FROM REAL PROPERTY of a felony, and upon conviction may be punished by a fine,imprisonment,or both.(RCW 46.12.210) fi MANUFACTURED HOME TPD/PLATE NUMBER GYIAH MLEJGTH/WIDTVEHICLEIDENTIFICATIONNUMBER!VIN)_, �p77 - OX0'4aq5 © LAND LEGAL DESCRIPTION ON PAGE REAL PROPERTY TAX PARCEL NUMBER MANUFACTURED HOME WILL BE AFFIXED 0 REMOVED LOT .7 BLOCK i PLAT NAME OR SECTION/TOWNSHIP/RANGE QUARTER/QUARTER SECTION © GRANTOR(S)REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE COUNTY NUMBER NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS 1 NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER ''y`/- (2S DOL CUSTOMER ACCOUNT NUMBER NAME OF ADDITIONAL REGISTERED OWNER ADDRESS CITY STATE ZIP CODE NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER L—D IS t S C rl(.L,). NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER ADDRESS CITY35 i --1 N. V e)o g C� `-�C— ,STATEZIP O 0-I GRANTEE NAME I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT I/WE AM/ARE THE REGISTERED OWNER(S)OF THIS VEHICLE AND THIS INFORMATION IS ACCURATE: i Signature of Registered Owner and Title, IF APPLICABLE-` _z.:2� � - --e-ef- Signature of Additional Registered Owner and Title,IF APPLICABLE `OTT\ AW\��A P NOTARIZATIOWCERTIFICATION FOR REGISTERED OWNER(S)SIGNATURE GHILOf// State of Washington Signed or attested ���.%%%%%NAA+ul�i4 ,/ County of ��1 -�— before me on s I b� Q.:74 4OT^� /�t'u% % byLL L. SC-hua�Z Signature `NI'Ir' at.LY�k�1/V� j v • - Z - PRINT NAME OF REGISTERED OWNER NOTARY A N / ; ( 1aec / � AVB �V it. by // N4,4/ 9-29-��r f� - PRINT NAME OF REGISTERED OWNER PRINTED Nk OF NOTARY // '9Or �,tllltt„\\"••. �� .. County/Office No.OR /�1 F FINPsa Title Ala-a. AND: Dealer No.OR 'hilt .� DEALERSHIP POSITION/ ENT/NOTARY Notary Expiration Date 4 /TITLE b'ii $ANY CERTIFICATION 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. © BUILDING PERMIT OFFICE CERTIFICATION Certify that: ID the manufactured home has been affixed to the real property as described. IEl a building permit has been issued for this purpose and the attachment will be inspected upon completion. NA E(TYPED OR PRINTED) BLDG PE IT OFFICE/PHONE# BLDG PERMIT# c t�� SMY.0 . <Ooh n60016,07 SI c URE/POSITION ` i`S� DATE 67TD-4 a-729 (R)S7 )W Pag 1 of I