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1992, 03-15 WA MH Application FILED �f7�ST=i£OFWAStrI-GTON MANUFACTURED HOME RECORDER'S CLOCK NAME AT THE REQUEST OF: LL.�� Department o/ lICEnSInG APPLICATION Please check one ADDRESS TITLE ELIMINATION(Complete all but section 3,below) TRANSFER IN LOCATION(Complete ALL sections below) REMOVAL FROM REAL PROPERTY(Complete all but section 4,below) El MANUFACTURED HOME TPO/PLATE NUMBER YEAR�� M�/�� 1� WIDTH/LENGTH VEHICLEIps--„2,6 IDENTIFICATION NUMBER(VIN) © LAND `Iry7 X(J (J� SOA/� Attach a copy of the legal description of your land. It can be obtained from your County PROPERTY TAX PARCEL NUMBER Assessors office or it may be typed or printed on an Additional Attachment Form(TD-420-732). Ora- ,i. 92),.S- Manufactured home will be 0 AFFIXED REMOVED © TITLE COMPANY CERTIFICATION i certify that the legal description of the land and ownership is true and correct per the real property records. NAME TITLE COMPANY/PHONE NUMBER SIGNATURE DATE X Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs. 4 BUILDING PERMIT OFFICE CERTIFICATION I ceJj�ify that the manufactured home has been affixed to the real property as described,or a building BLDG PERMIT# 1fmit has been ' sued for this purpose and the attachment will be inspected upon completion. jJ�/6 ME SIGNATURE/TITLE SPOKANE COUNTY BLDG PERMIT FFICE/PHO�N_,E/i DATE /a te X ptvtStON OF BUILDING AND PLANNINd. /1.7 )/ 10 e(IJ/5J j//�—!/�.3 OWNER IN ORMATION C FEES COUNTY# INC UNINC #REGISTERED OWNERS #LEGAL OWNERS Provide the Washington Driver's License or I.D. FILING FEE I I ❑ card number(PIC)for each owner: n N13E OF FIRST OWNER f&x 44' ,q 4'a " APPLICATION R -{� a /� - - �°yV�X E I )0lari . 6d2 ) \h op A. f G NAME OF SECOND OWNERMOBILE HOME FEES S E ADDRESS OF OWNER ELIMINATION E R :. ..c --OR--if the owner is a business, a� E Iacbf L. provide the Unified Business USE TAX D CITY STATE ZIP CODE Identifier(UBI),found on the `..>`P©sC' ./tffe 40/4— '905&' business Registration&Licenses NAME OF FIRST LEGAL OWNER' Document. SUB-AGENT FEES L I NMAILING ADDRESS OF FIRST LEGAL OWNER More than two owners or one TOTAL FEES&TAX H r b, lgd x 382-e lienholder? Please use attachment o L CITY / STATE ZIP CODE / form(s) #TD-420-732. $ L �277`�,� �� 98��7 D DEALER'S REPORT OF SALE E R 'SIGNATURE OF LEGAL OWNER INDICATES CONSENT FOR ELIMINATION OF TITLE/REMOVAL I certify that this information is correct. The vehicle is clear FROM REAL PROPERTY: X of encumbrances except as shown. Anyone who knowingly makes a false statement of a material fact is guilty of a felony,and WA DLR NO. DATE OF SALE PURCHASE PRICE upon conviction may be punished by a fine of up to$5,000 and/or 10 years imprisonment 03-67,9,z $,..sq, /di/ I -- (RCW 46.12.210). I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY LAW DEALER NAME TAX JURISDICTION/TAX RATE THAT I/WE ARE THE REGISTERED OWNERS• HIS VEHICLE AND THIS INFORMA- y� nn�� TION I RAT : Owne Ignature(s) ): !� �r �� DEALER'S AUTHORIZED SIGNATURE X X USE TAX EXEMPT Sale to a Certified Tribal member on X the reservation (attach notarized statement of delivery) NOTARY OR LICENSE AGENT&NUMBER SUBSCRIBED TO AND SWORN BEFORE ME THIS Residing in(County) X DAY OF 19 6 COUNTY AUDITOR/AGENT LICENSING OFFICE APPROVAL:(Not for use by Sub-Agents) I certify that the above application appears to have been completed c the - ant has sufficient documentation to proceed with the recording of this form. NAME SIGNATURE FFICI ••ERATOR NUMBER DATE X Tf-490.770 MANI IF HCIMF APPI (R/12/941M Paae 1 of 2