1995, 07-10 Title Elimination•
I`{rD
Please
X
pnrfminf o%�.•••�'V' MANUFACTURED HOME
IJfEI!SIflG APPLICATION •
check one
TITLE ELIMINATION (Complete all but section 3, below)
TRANSFER IN LOCATION (Complete ALL sections below)
REMOVAL FROM REAL PROPERTY (Complete all but section 4, below)
RECORDER'S CLOCK
FILED AT THE REOUEST OF:
NAME
ADDRESS
1 MANUFACTURED HOME
TPO/PLATE NUMBER
YEAR
1995"
MAKE
Modu fine.
WIDTH/LENGTH
. 8"I( 5.2
VEHICLE IDENTIFICATION NUMBER (VIN)
/ •'/576
7
2 LAND
Attach a copy of the legal description of your land. It can be obtained from your County
Assessor's office or it may be typed or
Manufactured home will be
printed on an Additional
AFFIXED
Attachment Form (TD -420-732).
REMOVED
PROPERTY TAX PARCEL NUMBER
�r'�� ft �0v
3 TITLE COMPANY CERTIFICATION
I certify that the legal description of the land and ownership is true and correct per the real property records.
NAME
TITLE COMPANY/PHONE NUMBER
SIGNATURE
X
DATE
Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs.
4 BUILDING PERMIT OFFICE CERTIFICATION
I certify that the manufactured home has been affixed to the real property as described, or a building
permit has been issued for this purpose and the attachment will be inspected upon completion.
BLDG PERMIT
CAS— \'\E
AME
. _ \. ck_c
SIGNATURE/TITLE
X SPOKANE COUNTY PERMIT CENTER
f BLDG PERMIT OFFICE/PHONE 1
I L(,- 3t -AS
DATE
t'-\ \\7AcS
5 OWN • INFORMA ION
FEES
COUNTY # INC UNINC
# REGISTERED OWNERS
# LEGAL OWNERS
Provide the Washington Driver's License or I.D.
card number (PIC) for each owner:
FILING FEE
R
E
G
NAME OF FIRST OWNER �/. J /
Karn !_ . -thcwl�
L
APPLICATION
I
T
NAME OF SECOND OWNER
Ilav'ic,, I• I-6re)
MOBILE HOME FEES
EADDRESS
R
E
OF OWNER
/171<g 0 Le) in �� f
lA--OR--
if the owner is a business,
ELIMINATION
D
CINSTATE
/)O4Lf
4ne
(L'1 7/�
ZIP CODE
9: (c,
provide the Unified Business
Identifier (UBI), found on the
business Registration & Licenses
USE TAX
1
NAME OF FIRST LEGAL O NEW
%PC)ar)P iYrif Way
recti f Un 'oil.
Document.
SUB -AGENT FEES
I
MAILING ADDR SS OF FIRST LE AL OWNER (
N
H
0
More than two owners or one
lienholder? Please use attachment
TOTAL FEES & TAX
0I. CITY
STATE
ZIP CODE
form(s) #TD -420-732.
$ I
E
DEALER'S REPORT OF SALE
R 'SIGNATURE OF LEGAL OWNER INDICATES CONSENT FOR ELIMINATION OF TITLE/REMOVAL
FROM REAL PROPERTY: X
I certify that this information is correct.
of encumbrances except as shown.
The vehicle is clear
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 of up to $5,000 and/or 10 years imprisonment
(RCW 46.12.210). I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY LAW
WA DLR NO.
DATE OF SALE
PURCHASE PRICE
THAT IA/VE ARE THE REGISTERED OWNERS OF THIS VEHICLE AND THIS INFORMA-
TION IS • CC 'ATE: Owner Signature(s) & Title(s):
DEALER NAME
TAX JUF liplcT T�1jt RATE
os �l�
A. l��
DEALER'S AUTHORIZED SIGNATURE �O
^®t' ' i
..47.;;...v
or'
�.
v* UQ` ••• gtoN 4.' • v
Xy A : •�
X
SO 1F
USE TAX EXEMPT Sale to4Certitip ritbRienrAllFittn N:
the reservation (attach notarizid statc>r1nt ofdeliv r
,
'/
SUBSCRIBED TO iiii• •N BEFORE ME THIS
DAY OF 19
Residing i; ounty) a t •
oN PU .LIC
N v
•'•��'�;,
<s,,,,,../49<,,,
6 COUNTY AUDITOR/ • GENT LICENSING OFFICE APPROVAL: (!tot for by Sub v
etl� -Agents) .,�
I certify that the above application appears to have been completed correctly, and the applicant has suft4 22com2• . u��jro
proceed with the recording of this form. �r�= t= VA-) t �s�
NAME
TD -420-729 MANUF HOME APPI rnr9rcA\1.41 P...e , ...1 ,1
SIGNATURE
X
OFFICENFS OPERATOR NUMBER
?
DATE Ill/i 1"--$�