2006, 10-16 WA State MH App RETURN ADDRESS
Reconveyance Services, Inc.
14090 Fryelands Blvd SE, #200
Monroe, WA 98272
Pl . , . • 4
JJt WASHINGTON STATE DEPARTMENT OF Manufactured Home (TITLE ELIMINATION
GZ•""m LICENSING Application ❑TRANSFER IN LOCATION
❑REMOVAL FROM REAL PROPERTY
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.(RCW 46.12.210)
® MANUFACTURED HOME
TPO/PLATE NUMBER YEAR MAKE LENGTH:WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN)
2000 PALMH 166 X 27 PH203722
9 LAND LEGAL DESCRIPTION ON PAGE .2
REAL PROPERTY TAX PARCEL NUMBER
MANUFACTURED HOME WILL BE [AFFIXED 0 REMOVED (45022.1402
LOT I BLOCK PLAT NAME OR SECTION/TOWNSHIP/RANGE QUARTER/QUARTER SECTION
Ptn of Tract 8,TRENTWOOD ORCHARDS I Vol M of Plats,Pg. 16
9 GRANTOR(S)REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE
COUNTY NUMBER NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS
SPOKANE 2
DOL CUSTOMER ACCOUNT NUMBER
NAME OF REGISTERED OWNER
EUGENE H.VANDORN
DOL CUSTOMER ACCOUNT NUMBER
NAME OF ADDITIONAL REGISTERED OWNER
IRIS R.VANDORN
ADDRESS CITY STATE ZIP CODE
P.O.Box 14694 SPOKANE VALLEY WA 99216
DOL CUSTOMER ACCOUNT NUMBER
NAME OF LEGAL OWNER
COUNTRYWIDE HOME LOANS
DOL CUSTOMER ACCOUNT NUMBER
NAME OF ADDITIONAL LEGAL OWNER
ADDRESS CITY STATE ZIP CODE
6007 N.DIVISION Spokane WA 99208 1
GRANTEE
NAME
State of Washington Dept.of Licensing to the Public
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:
Signature of Registered Owner and Title,IF APPLICABLE 2,--` ' �, ._A' i1--
Signature of Additional Registered Owner and Title,IF APPLICABLE i-
/ `�,:h.
``\�tUtilPt(� LORSTAMP NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER(S)SIGNATURE
*Y��k. VA....:Y4t. State of Washington Signed or attested
`, K•/•%ONE •T.-jib%., County of SPOKANE before me on 1 0 1 I 1 •
•ta *OURr ..t. by EUGENE H. VANDORN Signature
=" I ,..4-- = PRINT NAME OF REGISTERED OWNER
NOTARY OR:A
PUB%. : by IRIS R. VANDORN _ u ph.x;.41
h.
I.Y. ‘: PRINT NAME OF REGISTERED OWNER PRINTED NAME OF NOTA'
�, / V %.Q.;%,,$' County/Oftice No.OR
ealer No.
I'/ r"n n �```���� L Title DEALERSHIP POSITION/AGENT/NOTARY AND: Notary EDxpiration Date 11 /18/07
4 TITLE COMPANY 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
DATE
SIGNATURE/POSITION
Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs.
pIeASe- 5 BUILDING PERMIT OFFICE CERTIFICATION
trl,Iek • I ertify that: rg the manufactured home has been affixed to the real property as described.
0 a building permit has been issued for this purpose and the attachment will be inspected upon completion.
'AME(TYPED OR PRINTED)
BLDG PERMIT OFFICE/PHONE# BLDG PERMIT#
�4 \1�Cti�r1 f5CC F , '4 .) ) 99007343
. �'.,�"-I- ( <Al ./-�. DATE
'IGI IATURE/POsLT16f� �)
4 s, , ; , I IF:9s �y j y� (l�IIla(�V
TD-420-729 (R/b/ouj�ryge`1�of 2