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2010, 02-02 WA State MH App
AFTER RECORDING MAIL TO: First American Title 12209 East Mission #3 Spokane Valley, WA 99206 Filed for Record at Request of: Space above rh/s line for Recoiderc use only First American Title Insurance Company MANUFACTURED HOME PLEASE CHECK ONE �,of is(>r tv4 +,n,<<:z.,v X TITLE ELIMINATION " "°" `� �► APPLICATION IKE11,51TRANSFER 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 NUMBERYEAR MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN) %56621 11976 I Tamar 156 X 14 19106 © LAND LEGAL DESCRIPTION ON PAGE 2 REAL PROPERTY TAX PARCEL NUMBER MANUFACTURED HOME WILL BE QX AFFIXED n REMOVED 135241.2814 LOT BLOCK PLAT NAME OR SECTION/TOWNSHIP/RANGE OUARTER/OUARTER SECTION 30,31 4 Empire Heights Addition// © GRANTOR(S)REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE COUNTY NUMBER NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS TD0140 2 2 NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER Gary Mandick NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER Cheryl Mandick ADDRESS CITY STATE ZIP CODE 6921 East 6th Avenue,Spokane Valley,WA 99212 DOL CUSTOMER ACCOUNT NUMBER NA,m. OF LEGAL OWNER ` GI O(,,�')11 �J- (z,,�(J �C j e.2i i'S e V NAME OF ADDITIONAL LEGAL OWNER) DOL CUSTOMER ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE ' GRANTEE NAME Gary Manthey 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 APPLICABLE Signature of Additional Registered Owner and Title,IF APPLICABLE NOTARY SEAL OR STAMP i NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER(S)SIGNATURE State of Washington Signed or attested i County of Spokane before me on i I by Gary Mandick Signature i PRINT NAME OF REGISTERED OWNER NOTARY OR AGENT i I by Cheryl Mandick I PRINT NAME OF REGISTERED OWNER PRINTED NAME OF NOTARY I County/Office No.OR I Tits, Notary AND Dealer No.OR I DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Date 4 TITLE COMPANY CERTIFICATION I certify that the legal description of the land and ownership is true and correct T per Che COMPANY/PHONEreal pe NUMBER NAME(TYPED OR PRINTED) Tiffany Ipock,First American Title Insurance Company (509)456-0550 DATE SIGNATURE/POSITION Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs. © BUILDING PERMIT OFFICE CERTIFICATION the manufactured home has been affixed to the real property as described. I Certify that: n a building permit has been issued for this purpose and the attachment will be Inspected upon completion. NAM!(TYPED OR PWED) BLDG PERMIT OFFICE/PHONE# BLDG PERMIT# ( \errf Y. 1A5 - (cf6`6°-073'4 I Mtc ,5- SIGN TURE/POSTTION DA '� ? �P.,l- (►- 'bpi�, (* Z 12.-VO TD 2 729 MANUF AP R/2/02)OR(W)Page of i First American Title Fil No.4253-1514838(KG)