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2006, 02-01 Permit: 06000088 Title Elimination + i RETURN ADDRESS 11 VA 1)114 v�(�(k f_'i�i "u otv,(1 1,31-) CIcii�2 1.12Y5‘ 5Otn J •,1� s7aTcorwAsruNGTON MANUFACTURED HOME PLEASE CHECK ONE"'`°l uTITLE ELIMINATION IICEflSIflG APPLICATION DTRANSFER IN LOCATION Anyone who knowingly makes a false statement of a material fact is guilty BREMOVAL 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 I PLATE NUMBER YEAR MAKE LENGTWWIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN) %109071 1995 DARTM 60 X 28 114698 © LAND LEGAL DESCRIPTION ON PAGE REAL PROPERTY TAX PARCEL NUMBER MANUFACTURED HOME WILL BE a AFFIXED ID REMOVED 45204.2214A&45204.2214B LOT BLOCK PLAT NAME OR SECTION/TOWNSHIP/RANGE QUARTER/QUARTER SECTION Ptns 11 & 12 21 UNIVERSITY PL © GRANTOR(S)REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE COUNTY NUMBER NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS 2 2 NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER same as legal owner(s) NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER James G.D'Angelo NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER Coleen D.D'Angelo ADDRESS CITY STATE ZIP CODE 10517 East 14th Ave Spokane Valley WA 99206 GRANTEE NAME I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT I/ E AM/ARE THE REGISTEREf3 WN ( )OF IS VEHICLE AND THIS INFORMATION IS ACCURATE: ( Signature of Registered Owner and Title,IF APPLICABLE IA, '47'd Signature of Additional Registered Owner and Title,IF APPLICABLE NOTARY STAMP I NOTARIZATION/CERTIFICATION FOR REGISTERED OWNE'R(S)SIGNATURE `0111iflminuo 10 31Y,(�t�i�� I State of Washingto \\ Signed or attested ( `J •':5'• y4. I County off X((.l V` � before me on \F'I(-� �Cal w%, e, by Ae� -04, (� Signature "),* p P INT NAME OF REG TERE OW R NOTARY 'y! NT S••, ` PRINT NAME OF REGISTERED OWNER RINTED NAM Ol NOTARY i- •'p, ><�'�,. ( County/Office No.OR ......'' `y``�� TitleDEALERSHIPPJOS ON�GENT/ OTARY AND: Deallotary Expiration.OR �� "174 abril ...4% I r ▪ TITLEI6111 0,119►'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 days of the date Title Company Representative signs. ® BUILDING PERMIT OFFICE CERTIFICATION I Certify that: Athe manufactured home has been affixed to the real property as described. 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# �C��a� l , 32 (mac„ r SIGNATU E I POTION �� - /1 -; -\.0;k0 — 'k0TE TD-420.729 ANUFHOMEAPftl4L_.2/02)OR(W)Pagelof2 MANUFACTURED HOME - FROM SECTION 1 TPO I PLATE NUMBER YEAR MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN) %109071 1995 DARTM 60 X : 114698 6 SIGNATURE OF LEGAL OWNER SIGNATURE OF LEGAL OWNER INDICATES CONSENT FOR ELIMIN, ION OF E/RE ,• •L '•M 'EAL P . RTY. Signature of Legal Owner and Title,IF APPLICAB>,E j' ' 1 �r�/ s Signatur 'tonal Legal Owner and Title,IF APPLICABLE itkok.� �" .►�:L t-v �;uQitflSW�) , ��.P' su ��' -I NOTARIZATION/CERTIFICATION FOR LEGAL JNER(S)SIGNATURE ��• f+. %100 �i., State of Washington Signed or attested c �:eCounty of 1- _IL .4--k,L_k V before me on ' �' �' IA, i Es i .4-X* X t byr_kl,ACP �� 1 i ll ,) Signature �� +� Ilt Z PRINT NAME OF LEGAL OWN R NOTARYT''G 'T .,�1�A� M$ /�� by (1( L, b. ALk_c6c k > , .1 ti__ l. /-) �/ Nita •)��$ P INT NAME OF'LEGAL OWNER •RINTED NAM=• OTA'Y Q`� �( 43Z.,ONVtn" �`�` Title I V 1, AND: County/OfficeDealeNo.OR No.OR I V J/ 1((�'r) DEALER HIP S O AGENT/NARY Notary Expiration Date DLAND DESCRIPTION (A legal description of the land can be obtained from the local County Assessor's Office THE SOUTH 142 FEET OF LOTS 11 AND 12,BLOCK 21,UNIVERSITY PLACE,AS PER PLAT THEREOF RECORDED IN VOLUME"Q"OF PLATS,PAGE 19;SITUATE IN THE CITY OF SPOKANE VALLEY,COUNTY OF SPOKANE,STATE OF WASHINGTON. Ell DEALER'S 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 DEALER'S 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 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 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