2006, 01-26 Title EliminationRETURN ADDRESS
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L47p prEwtSHt:LTON MANUFACTURED HOME
kEnS IT/G APPLICATION
PLEASE CHECK ONE
TITLE ELIMINATION ■
TRANSFER IN LOCATION ■
REMOVAL FROM REAL PROPERTY
1
MANUFACTURED HOME,
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VEH.7L�DENG A NN IBE?b
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LAND ADDTONAL LEGAL DESCRIPTION ON PAGE
TITLE FEES
MANUFACTURED HOME WILL BE ■ AFFIXED • REMOVED
PR ' T PARC€L UMB R
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FILING FEE
APPLICATION
LOT
BLOCK
PLAT NAME
SECTION/TOWNSHIP/RANGE
MOBILE HOME FEE
A legal description
use the Applicat on
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can be obtained
Attachment
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from the local County Assessor's Office. If there is not enough room here,
to m, TD -420-[7a2,,, available at yourAuditor''sOffice.
local County at
i�tJ{� am 4 L/W Lrl
ELIMINATION FEE
USE TAX
SUB-AGENT FEES
TOTAL FEES & TAX
0 GRANTOR(S) REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE
COUNTY•
INGOHPORATED---UNINCOflPOflATED-',v
r1EOICTENED-OWNERO -
• LEGAL OWNGRG
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NAME OF FIRST REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
ADDRESS OF FIRST REGISTERED OWNER CITY STATE ZIP CODE
NAME OF FIRST Lggp�7GAL OW%NER__ C ACCOUNT NUMBER
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�,�)�t"&_-SO� �,.�� )r t/� /DO/LSC-USTOMER
/-f CITY STATE
WG- V M'L.z.of CODE
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ADDRE/SS_OF Fl (62—J'LE%G`/A'1i/ `•1`J-/I'Q�EI)R (7 • `...,.CV V`"('
GRANTEE(S) ADDITIONAL/iNAMES ON PAGE //
NAME OF FIRST GRANTEE DOL CUSTOMER ACCOUNT NUMBER
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 46.12.210)
I DO SOLEMNLY ATTEST UNDER PENALTY OF PURJURY
LAW THAT I / WE ARE THE REGISTERED OWNERS OF
THIS VEHICLE AND THIS INFORMATION IS ACCURATE:
SIGNATU OF LEGAL OWNER INDICATES CONSENT FOR
E 1 IN OF TITLE / REMO)14L FROM REA •• ROPERTY• X
X e 0/ i] /G���')�A _$JGNATURE OF FIRST REGISTERED OWNER AND TITLE. IF APPLICABLE
•/• `
SI WRREl/OFF T LO ERA TI E IF A PLICABLE SIGNATURE OF SECOND REGISTERED OWNER AND TITLE. IF APPLICABLE
NOTARY L OR STAMP 1 NOTARIZATION/ CERTIFICATION FOR REGISTERED OWNER(S) SIGNATURE
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/y Signed or atlested^� /�
Q� Q before me on I P V �!&
BRITT• POTTERn61
NOTARY PUBLIC .
STATE
Glgna ttekt
OF Wib' ter
EXPIRES JUNE 15, 2009
Title
Name of Applicant
Dealer No. OR
AND. County/Office No. 0R
Posnion/AgenUNOTARY Notary Expiration Date 4 I 73z?
DEALER'S REPORT OF SALE I certify that this Information Is correct. The vehicle Is clear of encumbrances except as shown.
DEALER NAME
WA DEALER NUMBER
DATE OF SALE
PURCHASE PRICE
TM JURISDICTION/TAX RATE
DEALER'S AUTHORIZED SIGNATURE
0 USE TAX EXEMPT Sale to a Certified Tribal member on the reservation (attach notarized statement of delivery).
rillLICENSING by Agents)
{w1
fy that the above application appears to have been comp a ed correctly, and theapplicant a t has sufficient documentation to
proceed with the recording of this form,
NAME (TYPED OR PRINTED)
COUNTY OFFICENFS OPERATOR NUMBER
SIGNATURE
DATE
TD -420-729 MANUF HOME APPL (R/12196)OR Page 1 of 2
INSTRUCTIONS AND ADDITIONAL INFORMATION ON REVERSE SIDE
U 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/POSITION DATE
Finalize this application with a Licensing Agent within 10 calendar days of the date Tile Company Representative signs.
6 BUILDING PERMIT OFFICE CERTIFICATION
I certify that the manufactured home has been affixed to the real property as described. OR a building permit has been issued for this
purpose and the attachment wit be Inspected upon completion
NAM 1\\,., 1`,, BLDG PEr,LOF�IC�/z PJ ,r n
`i 1 i\ '`Jj l`'`*�l
f DATE
SIGN /PO ON tin
l_ 7 Arb-PL .%ijull.t3 1)l'C.l Cc. ; (�(c
INSTRUCTIONS
COMPLETE THE APPROPRIATE BOXES ON THE FORM AS INDICATED BELOW,
DEPENDING UPON THE TRANSACTION YOU WISH TO PROCESS.
A. Manufactured Home Title Elimination Application (complete boxes 1, 2, 3, 4 and 6). Use to eliminate a title for a manufactured
home which is to become real property.
B. Manufactured Home Transfer In Location Application (complete all boxes). Use only when a manufactured home (whose
title has been eliminated) is being moved to land with a different legal description AND will become part of the real property to
which It will be moved and affixed. If the transfer in location is between two different counties, prepare this form in duplicate and
have each recorded in its respective county.
C. ManufacturedHome Removal From Real Property Application (complete boxes 1, 2, 3, 4 and 5). Use when titling a
manufactured home whose title has been previously eliminated. Once properly completed and recorded, this application
becomes a supporting document along with others required to apply for a Certificate of Title for the manufactured home.
IMPORTANT: SIGNATURES OF THE OWNERS ON THE MANUFACTURED HOME APPLICATION INDICATE TERMINATION
OF INTEREST IN THE MANUFACTURED HOME THROUGH TITLE PROVIDED BY CHAPTER 46.12 RCW AND INDICATE
INTENT TO PERFECT INTEREST IN THE MANUFACTURED HOME AS REAL PROPERTY WITH THE LAND HE/SHE/THEY
OWN AND TO WHICH IT IS/WILL BE AFFIXED. IF THE MANUFACTURED HOME IS BEING REMOVED FROM REAL
PROPERTY, SIGNATURES OF THE OWNERS PER THE REAL PROPERTY RECORDS INDICATE CONSENT TO THE
REMOVAL. THE FORM MAY THEN BE USED FOR MAKING APPLICATION FOR TITLE WITH THE DEPARTMENT OF
LICENSING AS PROVIDED BY CHAPTER 46.12 RCW.
Note: Owners of the manufactured home must own the land when the application is for a Manufactured Home The
Elimination or a Manufactured Home Transfer In Location, as provided by Chapter 65.20 RCW.
SECTION 1 Enter the description of the manufactured home.
SECTION 2 Place an "X" in the appropriate box and enter the property tax parcel number, lot, block, plat number and
section/township/range, when applicable. Write a legal description in the space provided. If there is not enough room,
"use the Title Application Attachment (TD0420-732). When processing a 'Transfer In Location Application,' both boxes
should be checked. The application must then be accompanied by two separate land descriptions.
SECTION 3 This area must be signed by all registered owners of the manufactured home when processing a title elimination. 11
the manufactured home has been sold and Is being removed from the real property, the owners per the real
property records must complete this portion to obtain a Certificate of Title. Signatures of the owners must be
notarized or certified by the selling dealer or a vehicle licensing agent. Fees will include a filing and application
fee plus sales or use tax due. Additional fees may Include: a title elimination fee and a Mobile Horne Affairs Fee.
Subagents will charge an additional service fee. (Fees are subject to change without notice.)
SECTION 4 Take the properly completed Manufactured Home Application and all necessary supporting documents to the County
Auditor/Licensing Agent Office for approval. Supporting documents may include but are not limited to: proof of
ownership or a Manufacturer's Statement of Origin (MSO), proof of taxes paid, and applicable release(s) of interest.
Subagents may not complete the approval portion of this form.
SECTION 5 The "Title Company Certification" box must be completed when processing a "Transfer In Location" or a "Removal
From Real Property" application. Important: The final recorded application form must be submitted to a vehicle
licensing agent within 10 days of the title company's certification.
SECTION 6 When processing an "Elimination" or "Transfer In Location" application, a city or county office (depending upon the
location of the manufactured home) must certify mai Ile home is affixed to the land;or, Issue.abuilding permit to affix
the manufactured home to the land, Inspecting the completed attachment. The issuing office must sign the
application, adding the permit number it the Inspection has not yet occurred.
IMPORTANT: Once the application has been approved by the County Auditor/Licensing Agent Office, take your application
form to the County Recording Office. Retain proof of the recording fees paid. If the Recording Office retains
your original application form, obtain a certified copy of the recorded form.
APPLICANTS: Once recorded, you must return to a Vehicle Ucensing office to file the Manufactured Home Application,
paying all required fees.
The Department of Licensing has a policy of providing equal access to its services.
11 you need special accommodation, please call (360) 902-3600 or TDD (360) 664-8885.
TD -420.729 MANUF HOME APPL (RN 2/96)OR Pape 1 of 2