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2001, 10-11 WA State MH Application • RETURN RECORDED DOCUMENT TO: First American Title Company 12209 East Mission Avenue Spokane, WA 99206 3, }rt9,1.5fISN iY I LT MANUFACTURED HOME PLEASE CHECK ONE T ,, ,tom APPLICATION x TITLE ELIMINATION licEnsinc TRANSFER IN LOCATION Anyone who knowingly makes a false statement of a material fact is guilty REMOVAL FROM REAL PROPERTY of afelony,and upon conviction may be punished by a fine,imprisonment,or both.(RCW 46.12.210) • El MANUFACTURED HOME TPO/PLATE NUMBER YEAR MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER MN) 57449L 1973 OLYNN 60 X 24 7303002603651 © LAND LEGAL DESCRIPTION ON PAGE 2 REAL PROPERTY TAX PARCEL NUMBER MANUFACTURED HOME WILL BE n AFFIXED 1 I REMOVED 35232.4210 LOT BLOCK PLAT NAME OR SECIION/TOWNSHIP/RANGE OUARTER/OUARTER SECTION 10 13 Carnhope Addition// © GRANTOR(S)REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE COUNTY NUMBER NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS ' 0140 2 2 • NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER Grady Chapman NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT.NUMBER Lisa Chapman ADDRESS CITY STATE ZIP CODE 4315 East 8th Avenue,Spokane,WA 99212 NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER Grady Chapman NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER Lisa Chapman ADDRESS CITY STATE ZIP CODE 4315 East 8th Avenue,Spokane,WA 99212 GRANTEE NAME G&L Investments LLC I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT I/WE /ARE TH GISTERED OWNER(S) OF THIS VEHICLE AND THIS INFORMATION IS ACCURATE: Signature of Registered Owner and Title,IF APPLICABLE �� ia,eY Signa(T to "Attitivl �Registered Owner and Title,IF APPLICABLE / ./14t--i LTC /', 7iii 1.4,0 A! "ti• �'�,' NOTARIZATION/CERTIFICATI bl'FOR ISTERED OWNER(S)SIGNATURE :, A r,S\On F.0/;6•........V• 1.;.` State of Washington Signed or attested a_ ,,� Z� '.� County of Spokane before me on ® - o p1AR Y N �: ..:til�,y Grady Chapman � Signatu�' �',..':i. w,' �` s'" �./� = :0 6 ® : I = PRINT NAME OF REGISTERED OWNER J OT;' - -" pUBLOC' :' . qv Lisa Chapman / .:- ... ' VA' /"/ IA' ' �i 0 20 3,•�/�`\ PRINT NAME OF REGISTERED OWNER -PRINTED ANT D AMEfice No.OR � �� 9 03;.•••��� `fir Title Notary AND Dealer No.OR 'i//y.�U F W PS\�\\\ ; DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Date j.••/;"�,/c3 ri TITLE CdMPANY-CERFIFICATION� I cert thf the legal description of the land and ownershi •s true and correct per the real property records. NA (TYPED OR PRINTED) JON' IIA&1.01.14/Z TITLE COMPANY/PHONE NUMBER First American Title Insurance Co ny (509)456-0550 SIGNA •OSITION .7'/7 L•/�__' i +v0A+_,. DATE q...34?7i/ Finalize this a.. ' • ion-mr' j l., gent within 10 calendar days of the date Title Company Representative signs. © BUILDING PERMIT OF CE 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. NAME P D OR PRINTED) I gilt ci,441 DO,pE,5 OFFI TONE Jkk(I� BLDG0PERMIT# Nf 1 � E� 1U `4d( 7j7jJJ J r V s�g.7ZOStYo f ljJ'`3 I S�. SI ATURE/PO DATE 1 ' Se4gtor Pe T L.Ve 61,4J 1. 10-11 -1 TD-420-729 MANUF HOME APPL(R/2/02)OR(W)Page of First American Title File No.4253-1728704(SB) MANUFACTURED HOME—FROM SECTION 1 TPO/PLATE NUMBER YEAR MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN) 57449L 1973 OLYNN 60 X 24 7303002603651 D SIGNATURE OF LEGAL OWNER SIGNATURE OF LEGAL OWNER INDICATES CONSENT FOR ELIMINATION OF TITLE/ OV L F OM REAL PROPERTY. Signature of Legal Owner and Title,IF APPLICABLE • Signature of Additional Legal Owner and Title,IF APPLICABLE NOTARY SEAL( M NOTARIZATION ,\\\\\\O" ` u�J�/////.A State of Washington /CERTIFICATION FOR LEGAL OWNER(S)SIGNATURE Signed or attested ) \\� \� •$ `O!1 E •.TTI//��/ County of Spokane before me on d74/ • \S X��N•1 bGrady Chapman sigaatwmC%- ' • > U ,_\O1A C =RINT NAME OF LEGAL OWNER -- e TAR / / C�N • �. rNOSAR ft`AGENT"�1"" PU��\C' r.yaisa Chapman r Ziha'zo,t •I Q \PRINT NAME OF LEGAL OWNER PRINTED NAME NOTARY • ' •A9_0 .2�?�' County ce No.OR s\ • e Notary AND Dealer No.OR T `Q�a )� DEALERSHIP POSITION AGENT NOTARY p/,Vj OF W P rr\\�\� / / Notary Expiration Date LAND dESCRI_ N(A legal description of the land can be obtained from the local County Assessor's Office) LOT 10, BLOCK 13,CARNHOPE ADDITION,ACCORDING TO PLAT RECORDED IN VOLUME"B"OF PLATS, PAGE 89,IN CITY OF SPOKANE VALLEY,SPOKANE COUNTY,WASHINGTON. pi DEALER'S REPORT OF SALE I CERTIFY THAT THIS INFORMATION IS CORRECT. THE VEHICLE IS CLEAR 0 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 JURISDIC)ION/TAX RATE DEALER'S AUTHORIZED SIGNATURE nUSE TAX EXEMPT Sale to a Certified Tribal member on the reservation(attach notarized statement of delivery) al 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 OFFICE/VFS OPERATOR NUMBER SIGNATURE DATE 10 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 ofproviding equal access to its services.If you need special accommodation,p/ease call(360)902-3600 or TDD(360)664-8885. TD-420-729 MANUF HOME APPL(R/2/02)OR(W)Page of