2007, 06-06 Title EliminationRETURN ADDRESS
OMNI CLOSING SERVICES
708 North Argonne Rd, Ste 11
S•okane Valley, WA 9 2 2
-SMS
- EASE CHECK ONE
Manufactured Home
r wASKurmTMN SSFIa1NLKG CIF 11�TITLE ELIMINATION
G LICENSING Application OTRANSFER 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 96.12.210)
1 MANUFACTURED HOME
TPO/ PLATE NUMBER
%78011
YEAR
1983
MAKE
NASHU
LENGTHANIOTHIFEET)
70 X 14
VEHICLE IDENTIFICATION NUMBER WIN)
370142BRCKR125504
2 LAND LEGAL DESCRIPTION ON PAGE 2
MANUFACTURED HOME WILL BE grAFFIXED 0 REMOVED
REAL PROPERTY TAX
45202.1707
PARCEL NUMBER
LOT
7
BLOCK
2
PLAT NAME OR SECTIOWTOWNSHIP/RANG
LACONNIE MOBILE HOME PARK
OUARTENOUARTER SECTION
3
GRANTOR(S) REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE
COUNTY
NUMBER
Spokane
NUMBER OF REGISTERED OWNERS
1
NUMBER OF LEGAL OWNERS
1
NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
Dale A. Smith
NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
ADDRESS CITY STATE LP CODE
9520 E. 7TH AVENUE SPOKANE WA 99206-6938
NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
Wells Fargo Bank, N.A.
NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
ADDRESS CITY STATE ZIP CODE
1 Home Campus Des Moines IA 50328-4603
GRANTEE
NAME
Dale A. Smith
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: , —/
1
..
Signature of Registered Owner and Tillie, IF APPLICABLE - 400—e.. al:
Signature of Ad•'
• •. Registered Owner and Title, IF APPLICABLE
nIOWCERTIFICATION FOR REGISTEREDOOWNER(S) SIGNATURE
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tate oNWeAR^9 r
County of Spraiant before me on �i hdo 7
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KT CMI>r• Signature 1) laiiLa
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' RINT NAME OF REGISTERED OWNER NOTAR AGENT
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PRINT NAME OF REGISTERED OWNER PRINTED NAME OF NOTARY
COunlyDealer
A •it OF`t'1P'Title
OF
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�%_ DEALERSHIP POSITION/AGENT/NOTARY Notary Esplka11O0 Date
4 TITLE COMPANY CERTIFICATION
I certify that the legal description of the and and ownership is true and correct per the real property records.
NAME (TYPED OR PRINTED) TRLE COMPANY/ PHONE NUMBER
SIGNATURE/POSITION DATE
Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs.
p
Pa BUILDING PERMIT OFFICE CERTIFICATION
certify that: O the manufactured home has been affixed to the real properly as described.
in a building permit has been Issued for this purpose and the attachment will be Inspected upon completion.
NAME (TY'ED OR PRINTED) BLDG PERMIT OFFICE/PHONE n
c - TSL- niV 1- - (.r:W."0703
BLDG PERMIT #
S 3 11 —7 ;IC/1
aIGNAT EIP9TION /� p p r7 DATE y�
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