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2006, 12-31 WA State MH Application • RETURN ADDRESS Verdna J. Davis 17714 E. 6th Avenue Greenacres, WA 99016 tiss74,Y` t f SHINGTON MANUFACTURED HOME PLEASE CHECK ONE 24 - - TITLE ELIMINATION /IcEnsInG 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) D MANUFACTURED HOME TPO/PLATE NUMBER YEAR MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN) @86038 1976 SISHM 64 X 24T 0S5633UX Et LAND LEGAL DESCRIPTION ON PAGE REAL PROPERTY TAX PARCEL NUMBER MANUFACTURED HOME WILL BE fi AFFIXED 0 REMOVED 55192 . 9046 LOT BLOCK PLAT NAME OR SECTION/TOWNSHIP/RANGE QUARTER/QUARTER SECTION PTN S19, T25N, R45E © GRANTOR(S)REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE COUNTY NUMBER NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS 1 0 NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER Verdna J. Davis biaV Irk\iJ5 1{-,S NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOM R ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE 17714 East 6th Avenue Greenacres WA 99016 NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE GRANTEE NAME Same as Registered Owner I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT I/WE AM/ARE THE REGISTERED OWNER(S)OF HIS VEHICLE AND THIS INFORMATION IS ACCURATE: Signature of Registered Owner and Title, IF APPLICABLE, • (WY/ Signature of Additional Registered Owner and Title,IF APPLICABLE NOTWORAUMKAMP NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER(S)SIGNATURE ` ���1GaETC/./�/yi,,�i' State of Washington Signed or attested `z; :•`0811158/p'••.•�S' County of Spokane before me on 12/29/06 Nor4 4 13,1 � jp ) =cn A�9A. fl _ bYVI"dna J_ Davis Signature N71..c';k''rl`11.N - fl�"et`ti\ �•. G�t/C W, PRINT NAME OF REGISTERED OWNER r FNI}O,YARY OR AGENT N` by ' EEct,.NA�n RIoUtran 1:11::...1:, O .1;')::D147:°°91 1.9 '• PRINT NAME OF REGISTERED OWNER P N D O A '� Coun /Office No.OR 7 HIND ::..z/ Title Notary AND: Dealer No.OR 5/19/0 9 �hh1,IIIi111111111� DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Date 4 T:74.41:::::..z/ TLE COMPANY CERTIFICATION I certify 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 She ry Stolz First American Title 509-838-5281 SIGNAT, /POSITION ✓� DATE �s, 4:::7/.. . Finalize this ap cation wi a Licensing Agent withicalendar days of the date Title Company Representative signs. 0 BUILDING PERMIT OFFICE CERTIFICATION I certify that: ❑ the manufactured home has been affixed to the real property as described. 0 a building permit has been issued for this purpose and the attachment will be inspected upon completion. NAME(TYPED OR PRINTED) BLDG PERMIT OFFICE/PHONE# BLDG PERMIT# 1•- i 0 1 -(vRP-02.03 L 340/(e (igi ATURE/P r•`SITIO • DATE 4* '$ ) -4-(2-1144., - /7�3, o 7 I- • V i HOME APPL(R/2/02 R()Page1of2 MANUFACTURED HOME - FROM SECTION 1 TPO/PLATE NUMBER YEAR MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN) @86038 1976 SISHM 64 X 24T 0S5633UX 6 SIGNATURE OF LEGAL OWNER SIGNATURE OF LEGAL OWNER INDICATES CONSENT FOR ELIMINATION OF TITLE/REMOVAL FROM REAL PROPERTY. Signature of Legal Owner and Title, IF APPLICABLE Signature of Additional Legal Owner and Title, IF APPLICABLE NOTARY SEAL OR STAMP NOTARIZATION/CERTIFICATION FOR LEGAL OWNER(S)SIGNATURE State of Washington Signed or attested County of before me on by Signature PRINT NAME OF LEGAL OWNER NOTARY OR AGENT by PRINT NAME OF LEGAL OWNER PRINTED NAME OF NOTARY County/Office No.OR Title AND: Dealer No.OR_ DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Date D LAND DESCRIPTION (A legal description of the land can be obtained from the local County Assessor's Office) THE EAST HALF OF THE WEST HALF OF THE SOUTHEAST QUARTER OF THE SOUTHEAST QUARTER OF THE NORTHWEST QUARTER OF SECTION 19 , TOWNSHIP 25NORTH, RANGE 45 EAST, W.M. ; EXCEPT THE NORTH 25 FEET THEREOF; AND EXCEPT THE WEST 16 FEET THEREOF; AND EXCEPT THE NORTH 163 . 66 FEET OF THE EAST 101 . 25 FEET THEREOF; IN THE CITY OF SPOKANE VALLEY, SPOKANE COUNTY, WASHINGTON. DEALERS REPORT OF SALE I CERTIFY THAT THIS INFORMATION IS CORRECT.THE VEHICLE IS CLEAR OF ENCUMBRANCES EXCEPT AS SHOWN. ANY REQUIRED SALES TAX HAS BEEN COLLECTED. DEALER NAME(TYPED OR PRINTED) WA DEALER NUMBER DATE OF SALE PURCHASE PRICE TAX JURISDICTION/TAX RATE DEALERS AUTHORIZED SIGNATURE 0 USE TAX EXEMPT Sale to a Certified Tribal member on the reservation(attach notarized statement of delivery). 9 COUNTY AUDITOR/AGENT LICENSING OFFICE APPROVAL: (Not for use by Subagents) 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(TYPED OR PRINTED) COUNTY OFFICENFS OPERATOR NUMBER. SIGNATURE DATE ro TITLE FEES FILING FEE APPLICATION MOBILE HOME FEE ELIMINATION FEE USE TAX SUBAGENT FEES TOTAL FEES&TAX IMPORTANT: Once the application has been approved by the County Auditor/Vehicle Licensing 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 Licensing office to file the Manufactured Home Application, paying all required fees. Vehicle licensing subagents charge a service fee. For full instructions on completing this form for Title Elimination, Removal from Real Property or Transfer in Location, see form TD-420-730, Manufactured Home Application Instructions. The Department of Licensing has a policy of providing equal access to its services. If you need special accommodation, please cal(360)902-3600 or TTY(360)664-8885. TD-420-729 MANUF HOME APPL(R/2/02)OR(W)Page 2 of 2