Loading...
2013, 07-25 WA State MH App 4 RETURN RECORDED DOCUMENTTO: a ' f VC K.-111 ?K1 . Vc <J�x 1e )UPOIDC(P CILWASHINGTON STATE DEPARTMENT OF Manufactured Home Please check one: LICENSING Application ► Ile Elimination For full instructions on completing this form,see Manufactured Home Application DTransfer in Location Instructions,form TD-420-730. ❑Removal from Real Property 0 Manufactured Home Si-hi 0 k9 ri ' LPO l Vehicl TPO/Plate number Year Make Length/Width(feet) ire tification number(VIN) I � -lo�it9� �, 'J Iu x 9--050 B Land `M nufactured home will be IA_ Real property !y f ) f f Affixed CI Removed Tax parcel no.S✓i`"11 l l Legal description on page Lot I I Block 2 Plat name or Section/Township/Range ip1VQuarter/Quarter section � a�l E iso 1 c1.vl © Grantor(s) Registered/Legal O ner(s)—Additional names on page County number No.registered owners No.legal owners Grantee name(if applicable) N e of registered owner r Washington driver license or UBI number C4111ha 11 t fe f p PePPE-92_q ?i-tl) Name of ddditional registered owner Washington driver license or UBI number Address(Address,City,State ZIP code) 19-�--0 E 14-4-hPc l/P_ cxjkl�V le a. 1110,ti IA/f-q q 01 G9 arme of legal ownei Washington driver license or UBI number Name of additi 1 legal owner Washington driver license or UBI number Address(Address, tate,City ZIP code) 19)1-1 EAVP} . c ti.e Gia ((vec Lea 42-4(4 I declare under penalty of perjury undeY the laws of the state of Wa'shington that I a./tw e the registered owner(s)of this manufactured home and the foregoing in a mi ti.• if true and c. r , [�I11111111111fIH11t111111NNlIfIN11111�7 X ��/ 'r , f / / Notary Public Signature. registered owner and title,if ap4'tr.le State of Washington I ' 1 Signature of additional regi ed owner and title,if applicable NotaMG'�F4�i I� = State ofw County of MY COMMISSION! _ n ao �� i October 21,:013 Signed or attested before m on CL X 1'(Seal orstamp) III) by.`P' UI IC i-FP llll��� by at°S II If R th Y islet ernrouti Pri r-Iiienne I Noj�rx printed or stamped name Notfr jgnatere i ' F-wCJ and V l Title Dealer/county office number or notary expiration TD-420-729(R/4/12)WA Page 1 of 3 Continued on next page Manufactured home TPO/Plate number(from Section 1) Q Title Company Certification INT or TYPE Name of person Isig�_n�ina (/ Title ompany name 10�..4'le Q 1 l(Jl�l.l / rt --n-tl{c Position (Area code)Telephone number l v Goq q-(H-I I certify that the legal description of the land and ownersris true and correct according to the real property records. I -11/11- 1 i i -7 hi-t /172 Signature Date © Building Permit Office Certification I certify that Atthe manufactured home has been affixed to the real property as described. ❑ a building permit has been issued for this purpose and the attachment will be inspected upon completion. PRINT or TYPE Na of person signing Building permit office Building permit number �,�c. fiee-c-40 .1- ec,5V '" -3333 Position + (Area code)Telephone number ref iK: 3- SPe_.,'ctil,' 5-i- t S-61- 720-531 LI 7 �--/3 )IA1/ e ,1_4,4.--7171--- -Date et(_- D Signature of Legal Owner(s) Signature of legal owner indicates consent for Elimination of Title or Removal from real property. X 4a4„ a ti-z-tiotiol-e- oimminimmtimmimilimmunmg Signature of legal 6wner and title,if applicable Notary Public a X a Signature of additional legal owner and title,if applicable State of Wtat:hiaslcl� s zify Noiarizati gfi LA� .e of u h ,Count of c') MY COMMIssION EXPIONIS iO'✓ 'DOI?J October21,2018 -d or attested before me o alnntfnllIIJllulllnllm — ' �' �a ' ' i� 1/1 (Seal or stamp) ."� ..I_ . I 1!' l�- by��+ rrfryt t4gi red orr p�r�e_ .�f„ f,,j_ PPrr.7 i�tgrg. n r e Nrary�Jir`tted or stamped name (jJ�� and xtary sif tt/ure , (3 Titlelt@'VV Dealer/countyPJoffice number or notary expiration 0 Land Description Legal description of land TD-420-729(R/4/12)WA Page 2 of 3 Continued on next page 4 • Manufactured home TPO/Plate number(from Section 1) Q Dealer Report of Sale—Selling dealer complete this section PRINT or TYPE Dealer name Washington dealer number Date of sale Purchase price Tax jurisdiction/Tax rate 0 Sales Tax Exempt—Sale to a Certified Tribal member on the reservation (attach notarized statement of delivery). I certify that this information is correct.The manufactured home is clear of encumbrances except as shown. Any required sales tax has been collected. X Dealer authorized signature 0 County Auditor/Agent Licensing Office Approval (not for use by subagents) PRINT or TYPE Name County office/VFS operator number I certify that the above application appears to be completed correctly, and the applicant has sufficient documentation to proceed with the recording of this form. X Signature Date 10 Title Fees Filing fee Application Mobile home fee Elimination fee Use tax Subagent fees Total fees and tax $0.00 Anyone who knowingly makes a false statement of a material fact is guilty of a felony,and upon conviction may be punished by a fine,imprisonment,or both.RCW 46.12.750 We are committed to providing equal access to our services. TD-420-729(R/4/12)WA Page 3 of 3 If you need accommodation,please call(360)902-3600 or TTY(360)664-0116.