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1995, 12-14 WA State MH App • STATE OF WASHINGTON RECORDER'S CLOCK FILED AT THE REQUEST OF: Ltig rtmvoi . MANUFACTURED HOME NAME lICEnSInG APPLICATION Please check one 0/_ gg 9_5—2 '/t /e9— 6 ADDRESS X, 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 YEAR MAKE WIDTH/LENG6 VEHICLE IDENTIFICATION NUMBE NO 5— 'sMx--\VA„u-LtAk G y 9 Q 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). J�-� Da Q Jib Manufactured home will be x AFFIXED REMOVED © 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 ce ' y that the m. ufactured home has been affixed to the real property as described, or a building BLDG PERMIT R per it has been;.• ed for this purpose and the attachment will be inspected upon completion. QC'" °9' NA / SIGNATURE TITLE SPOKANE COUNTY BLDG PERMIT, OF CE/PHONE M DATE • / X DIVISION OF BUILDING AND PLANNING (6W) 5& 3W5 /I05 WNER INFORMATION FEES COU # INC UNINC #REGISTERED OWNERS A LEGAL OWNERS Provide the Washington Driver's License or I.D. FILING FEE I 1 2 1 card number(PIC)for each owner: NAME OF FIRST OWNER APPLICATION E LEROY F WEST, JR I G NAME OF SECOND OWNER MOBILE HOME FEES s PATRICE J WEST I T E ADDRESS OF OWNER ELIMINATION R 19009 E 4th AVE, --OR--if the owner is a business, I E provide the Unified Business USE TAX D CITY STATE ZIP CODE GREENACRES VITA 99016 busineIdentifissrRegi(UBI),found on thec business Registration&Licenses I NAME OF FIRST LEGAL OWNER' Document. SUB-AGENT FEES • WASHINGTON MUTUAL BANK 578049326-7 I NMAILING ADDRESS OF FIRST LEGAL OWNER More than two owners or one TOTAL FEES&TAX N N 9604 NEWPORT HWY lienholder? Please use attachment L L CITY STATE ZIP CODE form(s) #TD-420-732. $ I E SPOKANE, WA 99218 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 $ I (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- TION IS ACCURATE: Owner Signature(s)&Title(s): DEALERS AUTHORIZED SIGNATURE X X X USE TAX EXEMPT SaleFIIIIEn X the reservation (attach notarized statement of delivery) NOTARY OR LICENSE AGENTS NUMBER SUBSCRIBED TO AND SWORN BEFORE ME THIS Residing in(County) X 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 1 612