2008, 01-03 Title EliminationAFTER RECORDING MAIL TO:
Pacific Northwest Title
120 W. Cataldo, Suite 200
Spokane, WA 99201
RECEIVED BY
CITY OF SPOKANE VALLEY
JAN 0 3 2008
BY:
Filed for Record at Request of:
Pacific Northwest Title Company of Spokane, Inc.
HOME
First American Title
Insurance Company
PLEASE CHECK ONE
Lyn; art' Oktai hlr,`TOPI ' '' •' - - _ - — _
.,,„ x
licEnS "D APPLICATION
Anyone who knowingly makes a false statement of a material fact is guilty
felony, and upon conviction may be punished by a fine, imprisonment, or both.
X TITLE ELIMINATION
TRANSFER IN LOCATION
I I REMOVAL FROM REAL PROPERTY
(RCW 46.12.210)
of a
1 MANUFACTURED HOME
TPO/PLATE NUMBER
YEAR
2006
MAKE
Palm
LENGTH/WIDTH (FEET)
52 X 27
VEHICLE IDENTIFICATION NUMBER (VIN)
2 LAND LEGAL DESCRIPTION ON PAGE 2
MANUFACTURED HOME WILL BE 1 XI AFFIXED I I REMOVED
REAL PROPERTY TAX PARCEL NUMBER
55192.1009
LOT
9
BLOCK
3
PLAT NAME OR SECTION/TOWNSHIP/RANGE
Apple Valley Estates//
OUARTER/OUARTER SECTION
3 GRANTOR(S) REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE
COUNTY NUMBER
0144
NUMBER OF REGISTERED OWNERS
NUMBER OF LEGAL OWNERS
NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
Leonard A. Benthien
NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
Linda M. Benthien
ADDRESS CITY STATE ZIP CODE
17208 East Coach Drive, Spokane Valley, WA 99016
DOL CUSTOMER ACCOUNT NUMBER
NAME OF LEGAL OWNER
Eagle Home Mortgage
NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
ADDRESS CITY STATE ZIP CODE
10510 NE Northup Way #300, Kirkland, WA 98033
GRANTEE
NAME
I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT I/W M/ARE HE EGI TERED OWNER(S) OF
THIS VEHICLE AND THIS INFORMATION IS ACCURATE:
Registered Owner and Title, IF APPLICABLE d��
Signature of
-7--......-0-...-- 7
Signature of Additional Registered Owner and Title, IF APPLICABLE -t, �y
•
.. ..
NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER(5) SIGNATURE
State of WashingtonSigned or attested
eon f( \ CA, C -C-1 at„ x0.06
-,:;� `3
DAWN GREEN
County of pe_)ita—,rn:,-
Leonard A. Benthien signat. a dt i.�- �� (1
TATE OF WASHINGTON
NOTARY o PUBLIC
by
PRINT NAME OF REGISTERED OWNERITARY OR A ENT
Linda M. Benthien a... &—re -''I^ -
I MY COMMISSION EXPIRES 08.28-2009
by
PRINT NAME OF REGISTERED OWNER PRINTED NAME OF NOTARY
County/Office No. OR JpGli
Dealer No. OR
Title Notary AND
DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Date C6_ - -DS - Oct
0, 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
Tracey Olson, Pacific Northwest Title Company of Spokane, Inc. (509)744-3434
SIGNATURE/POSITION DATE
Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs.
5
BUILDING PERMIT OFFICE CERTIFICATION
the manufactured home has been affixed to the real property as described.
I certify that:
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 #
f( 11« —iv 2 (3/--i-ice C C1 -,i OF SPG14-44)E1= t.)/11.07‘11 Cobs c0. S-
BLDG PERMIT #
, 069 OCO G�
. cel E /oma ( 26
SIGNAT4jRE/POSITION ole._
UI'/ll ( .� to!'. �vinT 5(-1—Z,Vzls 1-
First American Title File No. SPO -1015264 (DMG)
TD -420-729 MANUF HOME APPL
MANUFACTURED HOME — FROM SECTION 1
TPO/PLATE NUMBER
YEAR
2006
MAKE
Palm
LENGTH/WIDTH (FEET)
52 X 27
VEHICLE IDENTIFICATION NUMBER (VIN)
6 SIGNATURE OF LEGAL OWNER
SIGNATURE OF LEGAL OWNER INDICATES CONSENT FOR ELIMINATION
Signature of Legal Owner and Title, IF APPLICABLE
Signature of Additional Legal Owner and Title, IF APPLICABLE
OF TITLE/R�MOVAL FROpt'REAL P PERTY.
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NOTARIZATION/CERTIFICATION FOR LEGAL OWNER(S) SIGNATURE
of Washington LZ Signed or attested y I
coun of Oka1�>?' 1� �l 1 -. Ci I 0 L'
h _. t, v�G't before me on
Eagle Home Mortgage Signatue (,Q r �.
�/
> PRINT NAME OF LEGAL OWNER�ARY OR AGENT
4N. l (' _t7 15 I� JGc_ U L 5 �d-�UQ �.� ,1- y..� /N. pi._
PRINT NAME OF LEGAL OWNER PRINTED NAME OF NOTARY
County/Office No. OR �i b 1
I Title Notary AND Dealer No. OR ( L l l0
I DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Date
7 LAND DESCRIPTION (A legal description of the land can be obtained from the local County Assessor's Office)
LOT 9, BLOCK 3, APPLE VALLEY ESTATES, AS PER PLAT RECORDED IN VOLUME 9 OF PLATS, PAGE 26;
SITUATE IN THE CITY OF SPOKANE VALLEY, COUNTY OF SPOKANE, STATE OF WASHINGTON.
8 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 Afj1E (TYPED OR PRINTED)-
WA DE ER NU 'ER DATE
OF SALE
PURCHASE PRICE
TAX JURISD ON/TAX RATEDEALER'hS
AW .' ED SIGNATURE
! . ✓. ri /��
/
USE TAX EXEMPT Sale to a Certified Tribal member on the reservation (a notarized statement of de'v
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 OFFICE/VFS OPERATOR NUMBER
SIGNATURE DATE
10 TITLE FEES
FILING FEE APPLICATION MOBILE HOME FEE ELIMINATION FEE USE TAX
SUBAGENT FEES
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.
TOTAL FEES & TAX
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 cal/ (360) 902-3600 or TDD (360) 664-8885.
TD -420-729 MANUF HOME APPL (R/2/02)OR (W) Page of