2006, 12-19 Title EliminationRETURN ADDRESS
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LJSTATEOFWASHINGTON MANUFACTURED HOME
%BEDS%nG APPLICATION
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TITLE ELIMINATION
•TRANSFER IN LOCATION
• REMOVAL FROM REAL PROPERTY
Anyone who knowingly makes a false statement of a material tact Is guilty
of a felony, and upon conviction may be punished by a fine, Imprisonment, or both. (RCW 46.12.210)
1
MANUFACTURED HOME
reg/
r
eYATergiS Y R MAKE LENGTHMIIOTHFEET)
g62gq 11164 ID`ykE 5 x io
VEHICLE IDENTIFICATION NUMBER WIN)
64 SIo3
LAND Lok\2,'ti)WE9f \,Nil IA t o 19 LEGAL DESCRIPTION ON PAGE vo1omCIV.Ip9?i2.
HOME WILL BE AFFIXED •
REMOVED IRiQLr o ,R4Y�x�P�y�L,_Ju ER
MANUFACTURED
We*
2, t 51.14
BLOCK
I I
PLAT NAME c* M4Ir{CrsECTIO
TU? WKS %%RN E V t* K
/N/rOWNSHIP/RANGE
GrM OF 54cK1' IE VAu:
NAMES ON PAGE
GRANTOR(S) REGISTERED/LEGAL OWNER(S) ADDITIONAL
COUNTY
NUMBER
NUMBER OF REGISTERED OWNERS
I NUMBER OF LEGAL OWNERS
NAMEME
OF REGISTERED OWNER
D ouL i us
d w c3
NAME
YWNER
OIDDIT cGISTEREO OWNER
ADDRESS/
^
((.IJ D
Ave CITY /� o
a�rn
I _
I(Jr/n, gni
' lal . tiST
V W
ZIP CO/9Z/
(/j 9 Z / 2.
NAME
I((/ i
OF, LSSA 04 W{JER YY Do 106 1.A t 1 a
1 `/-YI `•MM'
NAME
OF AD^DDIT'IIOO,tNAA`L,yL_EGAL OWNER
ZIP COO�DEE
STATE ZIP
ADORES
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� D� — 3 _J / IAl CC'n�l�%tma cum- / r Z).
`/� �`TVe rx` (Alley
,y/ `.yl/[_JY�c%'Y
GRANTEE
NAME
I / WE AM/ RE THE - EGISTE�iOWNER(S) OF THIS
I
VEHICLE
DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT
AND THIS INFORMATION IS ACCURATE: /
011e
//.r, ...� �i' ae /'- A �
Signature of Registered Owner and Title, IF APPLICABLE'.' / ,__ >
Title, IF APPLICABLE
Signature of Additional Registered Owner and
R ifISTERED OWNER(S) SIGNATURE
NOTARY SEAL OR STAMP
NOTARIZATION/CERTIFICATION FOR
State of Washington .rte }}. Signed or attesteder
before me on /0v L/ O////W
County of `-/�bll140/I
'1- P)lh Arc%i( Wei Signature ,le.r i.'-(,�II/1!
by 'WI;Me./OF/ /,'
PRINT NAME EGISTERED OWNER NO ARY OR AGENT
PAINT
by»;c, P Alf-.491,1,urc, k
PRINT NAME OF REGISTERED OWNER PRINTED NAME OF NOTARY
Count'/Office No. OR
Dealer No. OR QUN�al
Title AltA(L/ AND:
DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Date
CERTIFICATION
4
I certify
TITLECOMPANY
that the legal description of the land and ownership is true and correct per the real property records.
TiE''jCOMP ANY /PHONE NUMBER .
?L��]/�-(,�
2,�/
NAME (TYPED OR PRINTED) �.B , ''/17,477
p/,qTE
SIGNAT)/ E/ ION / /• L-//��
days of the date Title Company Repr sen ive signs.
Finaliz
5
I
Is lication with a Licensing Agent within 10 calendar
BUILDING PERMIT OFFICE CERTIFICATION
certify that: he 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
OFFICE/PHONE Y
inspected upon completion.
BLDG PERMIT 1
NA E (TYPEDy��/EOR�PRINTED
o1'I 'II .C.r
BLDG PERMIT
^ //' `]/� �' ^.71-1-"Ni
III U(S ��`0V� \/ ^
N 1
DATE
ORE/POSITION \
'!tel 1
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"L (FU&9 OR Page 1 o12
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