1994, 07-29 WA State MH App E// STATE OF WASHINGTON
RECORDER'S CLOCK
(1 D(=arfwltwf OJ
1
lICEnSInG MANUFACTURED HOME APPLICATION
TITLE OPTIONS
Original 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 ': MAKEz•:::::-.::'.::::•:• -:::.-:-. >': :':WIDTH/LENGTH ->: :VEHICLE:IDENTIFICATIONNUMBER MNl ` `:' 'COLOR#1 - • COLOR I2
TOP ORBOTTOM OR
1979 Broadmore 14 x 65 3204 FRONT: IREARCOLOR:
2 _,ot 12, Block 3 MIDWAY ADDITION LAND
• ttat, i d uupy-uf the legal desciipuon of your land. It can be obtained from your Couity Assys�orr''s offEL ice.
PROPERT• Land to which the manufactured home is being:FX IAFFIXED n REMOVED 35)0, 63,N t
3 TITLE COMPANY CERTIFICATION
I certify that the legal description of the land and ownership are true and correct.
NAME `: • ;::TITLE COMPANYIPHO.NE.NUMBER. .. .:;: .. .SIGNATLNiE .•::: ... ,::
DATE • •
x
NOTE: Application must be finalized with a Licensing Agent within 10 calendar days of the date signed by the Title Company Representative.
4BUILDING PERMIT OFFICE CERTIFICATION
I certify that the manufactured home has been affixed to the real property as described, or the BLDG PERMIT S •
following building permit has been issued for this purpose and will be inspected upon completion. Q4o6135 Li
' .:..� ..; ... : ' BLDG PERMIT:OFFICE/PHONE NUMBER DATE
N .:: ; ; :::: •:;::EIGNATURFJTITLE -
`t-0\I 4-1 I/01- Z x j_ct,„±t, C3-C4 y6-6-34757- IO ---7 -79(_
OWNER/ RMATION *FEES
5 COUNTY N I INC UNINC NUMBER OF 1 NUMBER OF Please provide the Department of Licensing IDOL) FILING FEE
fl n REGISTERED OWNERS LEGAL OWNERS Client"NUMBER"for each owner:
R NAME OF FIRST REGISTERED OWNER APPLICATION
E .TOANN ALLARD / -i ti I l P I R.1 l 1\1519'151e it
t'
• NAME OF SECOND REGISTERED OWNER MOBILE HOME FEES
S I I I I I I I I I l l
T ADDRESS OF FIRST REGISTERED OWNER This"NUMBER" may be found on
E 7111 East 2nd Avenue your Washington Drivers License/ ELIMINATION
R STATE ZIPCo E I.D.Card–OR--if the owner is a
E CITY
D Spokane WA 99 12 business,provide the Unified USE TAX
NAME OF FIRST LEGAL OWNER• business identifier(UBI)number.
Joann Allard I I I ( I I I I I I I
SUB-AGENT FEES
MAILING ADDRESS OF FIRST LEGAL.OWNER
7111 East 2nd Avenue More than two registered or
CITY STATE ZIPCODE one legal owner? . . • TOTAL FEES &TAX
Spokane WA 99212 Please use attachment forms
• GNATURE OF OW DICA ES CONSE I0 (TD-420-732) i$ I
ELIMINATION OF•)TLE: X �.� ��/
Anyone who kno ' • • ake 1.false statement of a material fact is guilty DEALER'S REPORT OF SALE • PURCHASE PRICE
of a felony,and upon convict'.n may be punished by a fine of up to 85,000 .$
and/or 10 years imprisonment(RCW 46.12.210).I DO SOLEMNLY ATTEST I certify that this information is
UNDER PENALTY OF PERJURY LAW THAT I/WE ARE THE REGISTEREDcorrect. The vehicle is clear of TAX JURISDICTION/TAX RATE
OWNERS OF THIS VEHICLE AND THIS INFORMATION IS ACCO encumbrances except as shown.
Limier Sl nstun(sl: (Title)liPjM 161-1Vil&
'V \ / /► Q ;:;.tlEAicERNAME DATE OF SALE'
CSI
WADL:R:NO:: D:EALER'S.AUTHORIZED::SIGNATURE.•
XI ' • X
NOT OR LICE 1SF UMBER Subscribed orn to Before Me This Raiding in _ USE TAX EXEMPT saw to Indian on the
X .. r` A 1 Day15 9 4 • County Reservation(attach notarized statement of delivery)
6 COUNTY AUDIT RAGE LICENSING OFFICE APPROVAL:(Not for use by Sub-Agents)
I certify that the above applicat n appears to have been completed correctly, and the applicant
has sufficient documentation to proceed with the recording of this form.•
NAME ;; ::.:
i OFFICENFS OPERATOR NUMBER DATE •
7 RECORDING OFFICE
•This form has been recorded in the county records.
RECORDINGINUMBER. :.
r '_'z:: .COUNTY {'VOLUME/PAGE • DATE
TD-420-729 MANUF HOME APPUR/7/931OR Page 1 of 2