2010, 06-11 Title EliminationRETURN ADDRESS
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OcjAiu<r OFFtf SHIN: MANUFACTURED HOME - • A'.'®A
4 c 41y49TITLE
APPLICATION
ELIMINATION
■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)
1' MANUFACTURED HOME
TPO/
6
PLATE NUMBER
5 1.133
YEAR
i 9 7
MAKE
1,11o.0(t
LENGTH/WIDTH(FEET)
r--) u X I -I R
VEHICLE IDENTIFICATION NUMBER (VIN)
/ 5 e i Cal ft i /'icA .
21 LAND LEGAL DESCRIPTION ON PAGE 0 .
MANUFACTURED HOME WILL BE AFFIXED •
REMOVED
REAL P OPERTY TAX PARCEL'NUMBER.< t,,
c .� ti f r, e---/C� (Y'rr(.n,- ..,
-
LOT
(--.0L71
BLOCK
PLAT NAME OR SECTION/TOWNSHIP/RANGE
i'nn , ,-;nk ,ca.C=r ,Cc, bv1i 15 .CI i
QUARTER/OUARTER SECTION --
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3% GRANTOR(S) REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON:PIOE` ,^ :.
COUNTY NUMBER
NUMBER OF REGISTERED OWNERS
/'
NUMBEROFCEGALOXPJERS
NAME OF REGISTERED OWNERDdL.CSTOFRFCCOUNT NUMBER
I1- r, v) h 111 . I?�x r t < �S. Co I/7R7'/7.it/'
NAME OF ADDITIONAL REGISTERED OWNER bOL CUSTOMER ACCOUNT NUMBER
ADDRESS 1 CITY SSy�T110rtQ.. Jam, t\ STATE ZIP CODE
1 So� r,,-,, s, C,nT��L-a,Y� Auer S LJ 44'a.tLp
NAME OF LEGAL OWNER�1 C �/� DOL CUSTOMER ACCOUNT NUMBER
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141\�h(VlTh .1'1✓ E�k}S:\— tR nIc_-
NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
ADDRESS CITY STATE ZIP CODE
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GRANTEE J
NAME
f reT,n V. 'ir/1 l ente Is,,
1 DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT 1 / M/ARE THE REGISTERED OWNER(S) OF THIS
VEHICLE AND THIS INFORMATION IS ACCURATE: ,�fj/J /,/�/' 4Signature of Registered Owner and Title, IF APPLICABLE /'mil / /G/h/�a Y'
Signature of Additional Registered Owner and Title, IF APPLICABLE
NOTARY SEAL OR STAMP I NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER(S) SIGNATURE
Washington s Signed or attested
c //
unty of DCY92lG/� _ c0 , before me on 7// 7/cP -
SHAWN L. SURDE`TE
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OF WAS'rilNC�l'I�i ^' i- / ! �� •' •/l: /2/%/� I natg u�re ///%/-' ��/%i/
STATE PRINT
NOTARY-^°--P OSI.IC
AME OF REGISTERED OWNER 7ARY GENT'
o
i
�MY OONY MIYa}ON :XPIREi 0gimq-
I -The - `
AME OF REGISTERED OWNER PRINTED NAME OF NCt RY
County/Office No. OR
AND: Dealer No. OR
DEALERSHIP POSITION/AGENT/NOTARY -. Notary Expiration Date QV 9105j
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 days of the date Title Company Representative signs.
BUILDING PERMIT OFFICE CERTIFICATION
I Certify that ffthe 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.
NAM (TYPED OR PRIN ED) BLDG PERMIT OFFICE/PHONE 4
< IeS TJt\—SICK
BLDG PERMIT N
(�`SC3CQb ct
SIGNAT
RE / POSIT10� n
`f t DATE
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