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1995, 12-14 WA State MH App Lf7�STATE OF tVASFFFNCTON MANUFACTURED HOME RECORDER'S CLOCK FILED AT THE REQUEST OF: L1 DTATE eet of . l/CEnsInG APPLICATION NAME Please check one 01-889-577167-0 ADDRESS 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) 0 MANUFACTURED HOME TPO/PLATE NUMBER YEAQ5 MAKE WIDjy4Lpt�JH VEHICLE IDENTIFICATION NUMBER(VIN) �j ll bb L2S 115235 © LAND • Attach a copy of the legal description of your land. It can be obtained from your County Assessor's office or it may be typed or printed on an Additional Attachment Form (TD-420-732). PROPERTY TAX PARCEL NUMBER Manufactured home will be R AFFIXED REMOVED 55202.0110 © 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 t the manu actured home has been affixed to the real property as described, or a building BLDG PERMIT# perm' has been iss for this purpose and the attachment will be inspected upon completion. C 5--d--3 00 NAME /� SIGNATURE TITLE N ' X SPOKANE COUNTY BLRG PERMIT OFFICE/PHONE# DATE L DIVISION OF BUILDING AND PLANNING (5(��)/45� �5 / //i//(/ ® :ii,,, NER INFORMATION FEES COUNTY# INC UNINC #REGISTERED OWNERS #LEGAL OWNERS Provide the Washington Driver's License or I.D. FILING FEE 1 1 1 card number(PIC)for each owner: NAME OF FIRST OWNER APPLICATION RE MARGARET L KOBYLUS 0 NAME OF SECOND OWNER 1 MOBILE HOME FEES S EADDRESS OF OWNER ELIMINATION R 19001 E 4th AVE --OR--if the owner is a business, E 0 CITY STATE ZIP CODE provide the Unified Business USE TAX GREENACRES WA 99218 Identifier(UBI),found on the business Registration&Licenses NAME OF FIRST LEGAL OWNER' Document. SUB-AGENT FEES WASHINGTON MUTUAL BANK NMAILING ADDRESS OF FIRST LEGAL OWNER More than two owners or one TOTAL FEES&TAX H N 9604 NEWPORT HWY p lienholder? Please use attachment o clTY SPOKANE WA STATE 9192�D form(s) #TD-420-732. 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 THAT I/WE ARE THE REGISTERED OWNERS OF THIS VEHICLE AND THIS INFORMA- DEALER NAME TAX JURISDICTION/TAX RATE TION IS ACCURATE: Owner Signature(s)&Title(s): DEALERS AUTHORIZED SIGNATURE X X USE TAX EXEMPT Sale to ertifi T X the reservation (attach notarized statement of delivery) NOTARY OR LICENSE AGENT&NUMBER SUBSCRIBED TO AND SWORN BEFORE ME THIS Residing in(County) DAY OF 19 6 COUNTY AUDITOR/AGENT LICENSING OFFICE APPROVAL:(Not for use by Sub-Agents) I certify that the above application appears to have been completed correctly, and the applicant has sufficient documentation to proceed with the recording of this form. NAME SIGNATURE OFFICENFS OPERATOR NUMBER DATE X TD-420-729 MANUF HOME APPL(R/2/94)M Page 1 of 2