2008, 11-25 State of WA MH App RETURN ADDRESS
Manufactured Home PLEASE CHECK •N
CgWASHINGTON STATE DEPARTMENT AF (TITLE ELIMINATION
m LICENSING Application OTRANSFER 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)
II MANUFACTURED HOME
TPO/PLATE NUMBER I YEAR MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN)
11979 Buddy 70 X 14 04940215N
El LAND LEGAL DESCRIPTION ON PAGE
REAL PROPERTY TAX PARCEL NUMBER
MANUFACTURED HOME WILL BE [AFFIXED 0 REMOVED 55192.1208
LOT BLOCK )PLAT NAME OR SECTION/TOWNSHIP/RANGE OUARTER/QUARTER SECTION
8 1 I Apple Valley Estates First Addition
GRANTOR(S)REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE ._.._
COUNTY NUMBER I NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS
I
NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
The Bates Family Trust dated 7/122/04
NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
ADDRESS CITY STATE ZIP CODE
17216 E.3rd Avenue Spokane Valley WA 99016
NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
Same as Registered Owner
NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
ADDRESS CITY STATE ZIP CODE
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:
Signature of Registered Owner and Title,IF APPLICABLE '
JLet/et LQ
le-14=
Signature c.fk&GtotI(i al Registered Owner and Title,IF APPLICABLE
;°; �i I NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER(S)SIGNATURE
- %Nt li3O I State of Washington _ Signed or attested "1 I
;�„ OZ t`' County of 59:AL1T1\.+''G b fore me on
�w O '� ay (-elt�l(-4 SIC• tSP-f Signature
.i s ,0— ,, as
;I PRINT NAME OF REGISTERED OWNER N T OR AGENT
C - l � y fir'
$( 0-r. by Sr1....._� V 1'-1 k._
,00 4,1,44,45„..k 0� PRINT NAME OF REGISTERED OWNER PRINTED NAME OF NOTARY
Aon �� I ' County/Office No.OR
AS4�1® R Title 'N.)1-Tera-A/1.� a V A ./\.L� AND: Dealer No.OR �1 k l'��
DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Date
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
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
I certify that: 0�the manufactured home has been affixed to the real property as described.
..„,fiea' building permit has been issu6d for this purpose and the attachment will be inspected upon completion.
NAME(TYPED OR PRINTED) BLDG PERMIT OFFICE/PHONE# I BLDG PERMIT#
SIGNATUR /P 7110N .••"'"--R. DATE
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