2006, 04-06 Title Elimination•
RETURN ADDRESS
C. Raymond Eberle, P.S.
2610 N. Pines Road
Spokane Valley, WA 99206
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MANUFACTURED HOME
APPLICATION
a false statement of a material fact Is guilty
may be punished by a f ne, imprisonment,
TRANSFER
REMOVAL
(RCW
PLEASE CH CK ONE
ELIMINATION
IN LOCATION
FROM REAL PROPERTY
46.12.210)
❑TITLE
Ly
Anyone who knowingly makes
of a felony, and upon conviction
or both.
1r. MANUFACTURED HOME
TPO / PLATE NUMBER
YEAR
1998
MAKE
Fleetwood
LENGTH DTH(FEET)
44( 24
VEHICLE IDENTIFICATION NUMBER (VIN)
10SLV04AB211106W13
L� fd LAND LEGAL DESCRIPTION ON PAGE
MANUFACTURED HOME WILL BE [I AFFIXED
REAL PROPERTY TAX PARCEL NUMBER
45212.0927
11 REMOVED
LOT
BLOCK
PLAT NAME OR SECTION/TOWNSHIP/RANGE
OPPORTUNITY
OUARTER/OUARTER SECTION
3i GRANTOR(S) REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE
COUNTY NUMBER
NUMBER OF REGISTF�RED OWNERS
NUMBER OF LEGAL OWNERS
NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
Blazej Biela
NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
ADDRESS ITV STATE ZIP CODE
c/o 2610 N. Pines Road pokane Valley WA 99206
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 PERJUR
VEHICLE AND THIS INFORMATION IS ACCURATE:
Signature of Registered Owner and Title, IF
Signature of Additional Registered Owner and Title, IF
THAT 11 WE AM/ARE THE REGISTERED OWNER(S) OF THIS
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APPLI�rr ABLE 4,�d'e—�7>'try
APPLICABLE /
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State
by
by
Title
NOTARIZATION/CE
of Washington
County of
Blazej
k# TIFICATION FOR REGISTERED
Signed
S okane
or attested
before
OWNER(S) SIGNATURE
/
me on le -Q Co
4 -
Biela Signature
// EaeAh-
1C t�.
PRINT NAME
OF REGISTERED
----
WNER NOTARY OR AGENT
via K, Ebtrlt,
PRINT NAME OF REGISTERED WNER PRINTED
PRINTED
Notary
NAME OF
County/Office
AND:
Notary
NOTARY
No. OR
Dealer No. OR (1-15-0 6
,�
DEALERSHIP POSITION/AGEN /NOTARY
Expiration Dale
fl 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 alendar days of the date Title Company Representative signs.
SI BUILDING PERMIT OFFICE CERTIFICATION
I certify that: O the manufactured home has been aft] ed to the real property as described.
17 a building permit has been issued for his purpose and the attachment will be inspected upon completion.
NAME (TYPOR PRINTED) Bi MI 0
I C02 -0o
�IC,
BLDGPERMIT 11
Z.-
„frq
GNATURE PO TION
4 -17-E0
MANUFACTURED HOME - FROM SECTION 1
TPO/PLATE NUMBER
YEAR
1998
MME
Fleetwood
LENGTHANIDTH(FEET)
44 x 24
VEHICLE IDENTIFICATION NUMBER(VIN)
10SLV04AB211106W13
6
SIGNATURE OF LEGAL OWNER
SIGNATURE OF LEGAL OWNER INDICATES CONSENT FdR ELIMINATION OF TITLE / REMOVAL FROM REAL PROPERTY.
Signature of Legal Owner and Title, IF APPLICABLE,
Signature of Additional Legal Owner and Title, IF APPLICABL
NOTARY SEAL OR STAMP
NOTARIZATION/ ERTIFICATION FOR LEGAL OWNER(S) SIGNATURE
State of Washington Signed or attested
County of before me on
by
Signature
PRINT NAME OF LEGAL OWNE
by
ji NOTARY OR AGENT
PRINT NAME OF LEGAL OWNE
Title
PRINTED NAME OF NOTARY
County/Office No. OR
AND: Dealer No. OR
DEALERSHIP POSITION/AGENT/NOTARY
Notary Expiration Date
1
LAND DESCRIPTION (A legal description of the Ian
can be obtained from the local County Assessor's Office
The North two-thirds' of the North 390.4 ft. of the Eas
recorded in Volume "K" of Plats, page 20; EXCEPT t
thereof; AND EXCEPT the East 5 ft conveyed to Spo
Recording No. 5894910; situate in the County of Spo
reservations, and restrictions of record.
Commonly known as 11412 East 4th Avenue, Spo
half of Tract 193 of OPPORTUNITY, as per plat thereof
e West 133 1/3 ft. thereof; EXCEPT the South 170 ft.
ne County by Right of Way Deed recorded under
ane, State of Washington; subject to easements,
e, Washington 99206
pDEALER'S REPORT OF SALE
I CERTIFY THAT THIS INFORMATION IS CORRECT. THF,
ANY REQUIRED SALES TAX HAS BEEN COLLECTED.
VEHICLE IS CLEAR OF ENCUMBRANCES EXCEPT AS SHOWN.
I
DEALER NAME (TYPED OR PRINTED)
WA DEALER NUMBER
DATE OF SALE
PURCHASE PRICE
TAX JURISDICTION/TAX RATE
DEALER' AUTHORIZED SIGNATURE
U USE TAX EXEMPT Sale to a Certified Tribal mem r on the reservation (attach notarized statement of delivery).
COUNTY AUDITOR/AGENT LICENSING OFFICE APPROVAL: (Not for use by Subagents)
I certify that the above application appears to have been comple.ed
with the recording of this form.
correctly, and the applicant has sufficient documentation to proceed
NAME (TYPED OR PRINTED)
COUNTY OFFICENFS OPERATOR NUMBER
SIGNATURE
DATE
10
TITLE FEES
FILING FEE "
APPLICATION
MOBILE HOME FEE
ELIMINATION FEE
USE TAX
SUBAGENT FEES
MPORTANT: Once the application has been appro ed by the County Auditor / Vehicle
TOTAL FEES S TAX
Licensing Office, take your applicatio form to the County Recording Office.
Retain proof of the recording fees pai . If the Recording Office retains
your original application form, obtain certified copy of the recorded form.
APPLICANTS: Once recorded, you mu retum to a Vehicle Licensing office to file the
Manufactured Home Application, paying all required fees. Vehicle
If
licensing subagents ch a service fee.
For full instructions on completing this form fir Title Elimination, Removal from Real Property or
Transfer in Location, see form TD -420-730, Fylanufactured Home Application Instructions.
The Department of picensing has a policy of providing equal access to its services.
If you need special ccommodation, please cal (360) 902-3600 or TTY (360) 664-8885.
TD-420d29MANUF HOME APPL (R/2102)OR(W)Page2 oft