Loading...
2005, 09-06 WA State MH App • RETURN ADDRESS - i $-1- " 0-1 ) ( cit.-1 -TO- (k_ l.-g.:: pct I`‘,'1 < ` -i 6rt- 4,f--:-. ) , ii 0 y, Lc I,��1 A `F1 / La,LISTATE OF WASHINGTON MANUFACTURED HOME PLEASE CHECK ON De=rtmentof (TITLE ELIMINATION IICEflSIflG 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) 0 MANUFACTURED HOME TPO/PLATE NUMBER YEAR MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN) (IC,' I i_53 i 1,2 i 1 9 r 111yL:. -`l b X i Li l -)(2 11 © LAND LEGAL DESCRIPTION ON PAGE-.-4 REAL PROPERTY TAX PARCEL NUMBER MANUFACTURED HOME WILL BE'EI'AFFIXED 0 REMOVED 5 II; S ;,J\ , ( Z ( ,, LOT BLOCK PLAT NAME is-r SECTION/TOWNSHIP/RANGE © GRANTOR(S)REGISTERED/LEGAL OWNER(S) JADDITIONAL NAMES ON PAGE COUNTY NUMBER NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS NAME OF REGISTERED OWNER c;-.L.7._ ‘`'� l,_ iD\t-f.tiA..� NAME OF ADDITIONAL REGISTERED OWNER ADDRESS CITY STATE ZIP CODE 1'1 \ TLi�i� 1'\v . �i1�Lt-�� �cz\ \,_k_ t/:3\ cri 0 I1- NAME OF LEGAL OWNER NAME OF ADDITIONAL LEGAL OWNER ADDRESS CITY STATE ZIP CODE GRANTEE NAME '� "\- ( ) 1) �c k,, Lc, {' �,,v_ Y-- 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 APPLICABLECG�o (---<---2 �' , (� Signature of Additional Registered Owner and Title,IF APPLICABLE NOTARY SEAL OR STAMP NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER(S)SIGNATURE `````� p I's'irntiol,i State of Washington L1 Signed or attested c. 1 c.SEN SA.................. County of . k C't i k-&-_ before me on 414 f ' b �c`\C �_) 1.-L- "DV\- Signatufe;' '`LLCV�.��,Lv '\ut I ?WV+ Q1AAr •: ! y PRINT NAME OF REGISTERED OWNER _J J NO ARY OR AGENT 1 .V +-r "j v(1_1:, �E � \S 11 ld�V'�7.L t'1 •��4 .�t by ' Ilid O S PRINT NAME OF REGISTERED OWNER PRINTED NAME OF NOTARY , :� � p I County/Office No.OR ,r, VI:••;yAY 19.,:'�� :S Title 1�! l,' '1,4 ,i,\ AND: Dealer No.OR J c., 1�1f IOF ymm�,st`� DEALERSHIP POSITION/AGENT OTARY Notary Expiration Date 4 .Tl i iliCIAINHY1 vy 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. O BUILDING PERMITOFFICE CERTIFICATION I certify that: IDthe 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 inspected upon completion. NAME( YPED OR PRINT BLDG PERMIT OFFICE/PHONE# BLDG PERMIT# I ( 9..,i '00..ro,\_T\ (c) -c)--2_- slA SIGNATURE/ OSITION.- .,"------1 a � sra_ DATE TD-420- 29 MRNUF HOME APPL(R/818)17rfPege 1 of 2