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2006, 08-30 State of WA MH Application RETURN ADDRESS L47�ep�nmATtiOFent WAof SHINGTON MANUFACTURED HOME PLEASE CHECK ONEITLE ELIMINATION D 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) D MANUFACTURED HOME TPO/PLATE NUMBER YEAR . MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBS (VIN) )(3‘94 1C)X 1 LA U'I._ic:A f- 1C -1 Zio 12-x--1 © LAND LEGAL DESCRIPTION ON PAGE MANUFACTURED HOME WILL BE A AFFIXED 0 REMOVED REA ' j P CELIN'MBER LOT BLOCK PLAT NAME SECTION/TOWNSHIP/RANGE © GRANTOR(S)REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE COUNTY NUMBER NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS NAME OF REGISTERED OWNER L©1�Ci1 (A'k LLS NAME OF ADDITIONAL REGISTERED OWNER ADDRESS CITY STATE ZIP CODE 1011 l . _"a d'. t- Sp-.; vhukEut LAA 2 , NAME OF LEGAL OWNER kAL ..-s FP-(L-C -c K I ry 1M,Q-YL 1 ( NAME OF ADDITIONAL LEGAL OWNER 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 Signature of Additional Registered Owner and Title,IF APPLICABLE NOTARY SEAL OR STAMP NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER(S)SIGNATURE State of Washington Signed or attested County of before me on by Signature PRINT NAME OF REGISTERED OWNER NOTARY OR AGENT by PRINT NAME OF REGISTERED OWNER PRINTED NAME OF NOTARY County/Office No.OR Title AND: Dealer No.OR DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Date 4 TITLE 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 SIGNATURE/POSITION DATE Finalize this application with a Licensing Agent within 10 calendar daye of the date Title Company Representative signs. © BUILDING PERMIT OFFICE CERTIFICATION I Certify that: 0 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 C BLDG PERMIT 11 SIGNATURE/PO ITION DATE To-420-729v ANUF HOME A L(R/9/90)OR Pae I of 2