1992, 04-09 Title EliminationManufactured Home:
Year , �‘C2 Make **/
Vehicle Identification Number C-k'c% S % ( 3 S
Registered Owners:
Names Signature&
Legal Owners:
Names Signature&
'SIGNATURES OF OWNERS INDICATE TERMINATION OF INTEREST IN THE MANUFACTURED HOME THROUGH TITLE PROVIDED BY CHAPTER 46.12 RCW AND
INDICATE INTENT TO PERFECT INTEREST IN THE MANUFACTURED HOME AS REAL PROPERTY WITH THE LAND HE/SHE/THEY OWN AND TO WHICH IT IS/IS
BEING AFFIXED.
Width iQ ‘,i) Length
Land to Which Manufactured Home is Being Affixed:
Property Tax Parcel Number /9'55 a 2 (a 03
Legal Description
Owners' Names
r JLazaligat ' , W' R,Th Signaturesr�l�'yY�t1
'SIGNATURES OF OWNERS INDICATE CONSENT TO HAVE THE MANUFACTURED HOME ADDED O HE REAL PROPERTY LISTED ABOVE.
Building Permit Office Certification:
I certify that the manufactured home has been affixed to the real property as described above and/or building permit
number A - A15o S has been issued for the purpose of affixing the manufactured home to the land and will be
inspected upon c; pletion. , SPOKANE COUNTY
BUILDING & SAFETY
NAME
SIGNATURE
BLDG. PERMIT OFFICE
Y-9 9-1
DATE
5/sL-,?47s"-
PHONE NUMBER
County Auditor/Agent Licensing Office Approval: (Not for use by subagents)
I certify that the above application appears to have been completed correctly, and that the applicant has sufficient
documentation to proceed with the recording of this form.
NAME
SIGNATURE
OFFICE/CAAP OPERATOR NUMBER
DATE
Recording Office:
I certify that this form has been recorded in the county records.
NAME
SIGNATURE COUNTY DATE RECORDING NUMBER
Note: Every person who falsifies or intentionally omits material information required in an affidavit is guilty of a gross
misdemeanor punishable in accordance with RCW 9A.20.021.
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