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2010, 03-16 State of WA MH App . ice -S AFTER RECORDING MAIL TO: First American Title Company 12209 E. Mission #3 Spokane, WA 99206 Filed for Record at Request of: space above tb/s rye for Recorders use only First American Title Insurance Company di(n...I rMeiNGis ioae .IN tf MANUFACTURED HOME PLEASE CHECK ONE XX "` 'mn APPLICA'T'ION TITLE ELIMINATION 10EnSG n TRANSFER IN LOCATION Anyone who knowingly makes a false statement of a material fact is guilty n REMOVAL FROM REAL PROPERTY of a felony,and upon conviction may be punished by a fine,imprisonment,or both.(RCW 46.12.210) 0 MANUFACTURED HOME TPO/PLATE NUMBER I YEAR MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN) fl4757 [1978 CNCTjM 56 X 24 0225_5LAND LEGAL DESCRIPTION ON PAGE 2 REAL PROPERTY TAX PARCEL NUMBER MANUFACTURED HOME WILL BE 2 AFFIXED D REMOVED 55192.1307 LOT BLOCK PLAT NAME OR SECTION/TOWNSHIP/RANGE OUARTER/OUARTER SECTION 7 2 //Apple Valley Estates 1st © GRANTOR(S)REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE COUNTY NUMBER NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS 0144 1 0 NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER Carl K.Crouch NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE 8017 South Vicari,Spokane Valley,WA 99206 NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE / GRANTEE 1 NAME Same as Above I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT I/WE RE REGISTERED OWNER(S) OF THIS VEHICLE AND THIS INFORMATION IS ACCURATE: Signature of Registered Owner and Title,IF APPLICABLE X , ./ I Signature of Additional Registered Owner and Title,IF APPLICABLE NoTAN thil STAMP NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER(S)SIGNATURE ‘GPEICH F//N�s,� State of Washington nty of Spokane Signa eeto November 2, CX P_ OSS10;•':9• by Carl K.Crouch Si na re `` rr FA 71 a e - NO,r �1. Z` i PRINT NAME OF REGISTERED OWNER NOTARY OR AGENT ` rn. _ by Gretchen Satran .0 W• = I PRINT NAME OF REGISTERED OWNER PRINTED NAME OF NOTARY { 9 .�i GeLIC I County/Office No.OR l is 1 1 `" ��'•9{- Tine Notary AND Dealer No.OR --' �' j 19 o , 209. ��' I DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Date rili/Tifetg PROVCERTIFICATION I certify WItittIO gal description of the land and ownership is true and correct per the real property records. NAME(TYPED OR PRINTED) TITLE COMPANY/PHONE NUMBER Sherry Stolz,First American Title Insurance Company (509)838-5281 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: the manufactured home has been affixed to the real property as described. a building permit has been Issued for this purpose and the attachme[n]t will be inspected upon completion. NA (TYPED OR PRI ) BLDG PERMIT OFFICE/PHONE# ` I `'`'L4C� BLDG PERMIT# MOQrwc. Vjw1 1 16 iC`C', ( f t SIGNA REPOSITION DAT TD- 20- •MAN 'OME APIti 2/ •• • ` �,da First American Title File o.425 -913944(GS)