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1995, 12-22 WA State MH App
Li DrpartSTATE mrOFntWof ASHINGTON MANUFACTURED HOME RECORDER'S CLOCK FILED AT THE REQUEST OF: 1 licEnsinGAPPLICATION NAME Please check one ADDRESS _la- TITLE ELIMINATION(Complete all but section 3,below) TRANSFER IN LOCATION(Complete ALL sections below) REMOVAL FROM REAL PROPERTY(Complete all but section 4,below) 1113 MANUFACTURED HOME TPO/PLATE NUMBER 'YEAR MAKE WIDTH/LENGTH VEHICLE IDENTIFICATION NUMBER(VIN) 1971 Glenbrook 14 x.66 © LAND Attach a copy of the legal description of your land. It can be obtained from your County PROPERTY TAX PARCEL NUMBER Assessor's office or it may be typed or printed on an Additional Attachment Form (TD-420-732). 55192.1201 Manufactured home will be ra AFFIXED REMOVED A TITLE COMPANY CERTIFICATION I certify that the legal description of the land and ownership is true and correct per the real property records. NAME TITLE COMPANY/PHONE NUMBER SIGNATURE DATE X Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs. 4 BUILDING PERMIT OFFICE CERTIFICATION I certif 'at the manufactured home has been affixed to the real property as described, or a building BLDGPERMITI J-50K57",permi has been issu � r this purpose and the attachment will be inspected upon completion. gr I NAME (Aet ,� r SIGNATURE/TITLE rSPOKANE COUNTY BLDG PERMIT O FICE/PHONE M DA X DIVISION OF BUILDING AND PLANNING � -��'}ftp ��`�l�r�- /e--/ 29 Ei NER INFORMATION / (� /FEES/' COUNTY I INC UNINC ft REGISTERED OWNERS #LEGAL OWNERS Provide the Washington Driver's License or I.D. FILING FEE i I I card number(PIC)for each owner: NAME OF FIRST OWNER APPLICATION R E HAMILTON, PATRICK A. G NAME OF SECOND OWNER MOBILE HOME FEES 1 T• HAMILTON, ARLENE A. E ADDRESS OF OWNER ELIMINATION E 17105 EAST 4TH AVENUE --OR--if the owner is a business, D CITY STATE ZIP CODE provide the Unified Business USE TAX GREENACRES WA 99016 Identifier(UBI),found on the business Registration&Licenses NAME OF FIRST LEGAL OWNER' Document. SUB-AGENT FEES L I COUNTRYWIDE FUNDING CORP. N MAILING ADDRESS OF FIRST LEGAL OWNER More than two owners or one TOTAL FEES&TAX H lienholder? Please use attachmento @ L CITY STATE ZIP CODE form(s) #TD-420-732. $ D E DEALER'S REPORT OF SALE R 'SIGNATURE OF LEGAL OWNER INDICATES CONSENT FOR ELIMINATION OF TITLE/REMOVAL I certify that this information is correct. The vehicle is clear FROM REAL PROPERTY: X of encumbrances except as shown. Anyone who knowingly makes a false statement of a material fact is guilty of a felony,and WA DLR NO. DATE OF SALE PURCHASE PRICE upon conviction may be punished by a fine of up to$5,000 and/or 10 years imprisonment (RCW 46.12.210). I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY LAW DEALER NAME TAX JURISDICTION/TAX RATE THAT I/WE ARE THE REGISTERED OWNERS OF THIS VEHICLE AND THIS INFORMA- TIO CC GOwner Signa uree(s) (8): &TT / / X Q[ C ��'�� "� /2/22 S DEALER'S AUTHORIZED SIGNATURE ')Dt_ v` l- k ee~ -')...72. t C USE TAX EXEMPT Sale to a Certified Tribal member on X ` +N0111111Iftttt,zj/ - ,�,.,tSWORN the reservation (attachnotarized statement of delivery) NOTARY OR 'ENSE AGENT MBER - , � . 'IQL. D-f BEFORE yfTHISResidingin(County)y � tt��4�Wsl !¢y ♦'.L.Q)91 lam—"l 19 6 COUN Y AUDITOR/AGENT L NIP V4:(Not for use by Sub-Agents) I certify that the above applicatign appears-tat vetiE#en completed correctly, and the applicant has sufficient documentation to proceed with the recording of tht5rfprm. PinBtutc NAME % -A% SIGfartVrE • :: OFFICENFS OPERATOR NUMBER DATE TD-420729 MANUF HOME APPL(R/12/94)M Page 1 of 2 /!gJf171j 1 i.I,+1"0