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2007, 11-16 WA State MH Application Jacqui Tarter L.Y.V. Real Estate Closer ✓�� OKANE • ''+r OUNTY L.,_ _ __ :i ITLE Northbank Bldg.,Suite 203 '77 1010 North Normandie b Spokane,WA 99201 C dip.I.H.S ='S rvik:e is The Difference" V1q17) (AX 324-1375 jtarter@spokanetitle.com Phone 326-2626 I ? 1010 N NORMANDIE STE 203 -� �' �4,r''"' /0 SPOKANE WA 99201 �� "' %"=.� 1 II 5/604age e440fre, S . (509) 326-2626 Manufacturea home ' ONE W6SIIINOrONSTATE DEPARTMENT OF [TITLE ELIMINATION / ,) * LICENSING .Application ❑TRANSFER IN LOCATION • (G A Anyone who knowingly makes a false statement of a material fact is guilty DREMOVAL FROM REAL PROPERTY ' /ff`�' of a felony, and upon conviction may be punished by a fine,imprisonment,or both.(RGW 46.12.210) i� D MANUFACTURED HOME �' , TPO/PLATE NUMBER YEAR MAKE LENGTWWIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN) . /1 ( 16 Y`I 1972 KENTWOO 68 X 24 KW582 V © LAND LEGAL DESCRIPTION ON PAGE 2 REAL PROPERTY TAX PARCEL NUMBER MANUFACTURED HOME WILL BE ZAFFIXED 0 REMOVED 35242.2514 LOT BLOCK PLAT NAME OR SECTION/TOWNSHIP/RANGE OUARTER/OUARTER SECTION Ptn Lts 6&7 1 APPLE WAY HEIGHTS © GRANTOR(S)REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE r!I �jQS COUNTY NUMBER N2UMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS 1 ,� I L C Ai V'I l r cep5et NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER b! (ve,r5 JAMES D VAN GILDER k NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBERtk:.; ID / [� VICKY L VAN GILDER ..c c_ ADDRESS CITY STATE DP CODE 6503 E 7TH AVE SPOKANE VALLEY WA 99212-0581 NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER AMERICAN GENERAL FINANCE I NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER 1� j"(C -'^ C7e_r - ADDRESS CITY STATE ZIP CODE 300 N MULLAN RD STE 103 SPOKANE WA 99206 (_g -r- GRANTEE GRANTEE NAME JAMES D. VAN GILDER;VICKY L. VAN GILDER I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT I/WE AM/ARE THE REGISTERED OWNER(S)OF THIS rr—_ VEHICLE AND THIS INFORMATION IS ACCURATE: Signature of Registered Owner and Title,IF APPLICABLE X VA/V Signature of Additional Registered Owner and Title,IF APPLICABLE X 1 NOTARY SEAL OR STAMP 7 NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER(S)SIGNATURE �f� _ State of Washington Signed or attested J ktt-S ( �) County of Spokane before me on 11/, /2007 �A�, James D. Van Gilder AiOf,K 1 i by _ Signature PRINT NAME OF REGISTERED OWNER NOTARY OR AGENT by Vicky L. Van Gilder - PRINT NAME OF REGISTERED OWNER PRINTED NAME OF NOTARY County/Office No.OR A/Win 5 Title Notary PublicAND: Dealer No.ORDEALERSHIP POSITIOWAGENT/NOTARY Notary Expiration Date a�(k\ ANY CERTIFICATION G( i ( ( 1^ gal description of the land and ownership is true and correct per the real property records. N V�/ NTED) TITLE COMPANY/PHONE NUMBER f 44,} ( IUNTY TIME COMPANY (509)326-2626 N DATE eoV(?r � �rhl �T(-1,\,,4,4t1 � I" cation 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. Certify that: E building permit has been issued for this purpose and the attachment will be inspected upon completion. tUA (rb f NAME TYPED OR PRINTE[ BLDG PERMIT OFFICE/PHONE# BLDG PERMIT N � \T-F- 1.. VV (( CG-- �2 3 f 111J5 '���%%%1 SIGN 'URE/POSITION DTE N.�r� i i-- ec pro t o t-- 1( I4' O7 EE729 (R/6/06)W P.!ET 1 of 2 1