2008, 12-12 WA State MH Application RETURN ADDRESS
Manufactured Home /74�` T4ig:r4grffe1'y11
WAS IIN&TON SLATE DEPARTMENT OF (TITLE ELIMINATION
LICENSING Application ❑TRANSFER 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)
MANUFACTURED HOME
TPO/PLATE NUMBER I YEAR MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN)
$40510 1978 Brookwood 28 X 68
• LAND LEGAL DESCRIPTION ON PAGE
REAL PROPERTY TAX PARCEL NUMBER
MANUFACTURED HOME WILL BE [AFFIXED 0 REMOVED 551920709
LOT I BLOCK i PLAT NAME OR SECTION/TOWNSHIP/RANGE QUARTER/QUARTER SECTION
1 j
• GRANTOR(S)REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE
COUNTY NUMBER I NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS
i
J
NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
Susan Christenson C...-I-1 RSSt'h Ll 3 ILL...;
NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
ADDRESS CITY STATE ZIP CODE
17604 E.6th Avenue Spokane Valley WA 99016
NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
Same as Registered Owner
NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
ADDRESS CITY STATE ZIP CODE
GRANTEE
NAME
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�k- 44..
Signature ofVi Registered
fistered Owner and Title,IF APPLICABLE _..........__..........._.._.._......_...._..._.... _
No LEituq j NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER(S)SIGNATURE
= �SR�r State of Washington Signe. or attested
��YY ��/r County of , Pr b=fore me on lt_4C11 Og
z OT #,
• a
's Illy S -5 L-)-+tta S-r S-4 Signature
S� ® %A;by
PRINT NAME OF REGISTERED OWNER N•TAARY OR AGENT
A 8�®C, IC-0-4_' ._15�?tt
/,• '9171.141-24-„W41`4 PRINT NAME OF REGISTERED OWNER PRINTED NAME OF NOTARY
C -1 County/Office No.OR
I an Title � � 1'7�1r AND: Dealer No.OR t--t.�1\' t
�"e a !7 i DEALERSHIP POSIT N/AGENT/NOTARY Notary Expiration Date
` TITLE COMPANY CERTIFICATION
Icertify that the legal description of the land and ownership is true and correct per the real property records.
NAME(TYPED OR PRINTED) TITLE COMPANY/PHONE NUMBER
SIGNATURE/POSITION DATE
Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs.
El BUILDING PERMIT OFFICE CERTIFICATION
I certify that: 0 the manufactured home has been affixed to the real property as described.
rf'a building permit has been issued for this purpose and the attachment will be inspected upon completion.
NAME(TYPED OR PRINT ) BLDG PERMIT OFFICE/PHONE# 1 BLDG PERMIT#
SIGN\URE/POSITIONDATE i (,.../
TD, .9 (R/6/06)W Pa,- -