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2010, 06-11 Title EliminationRETURN ADDRESS TJ7"i4/ �O 4» n T a Cc_3\-lc\c9 q c3\ 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 -- b : .< .::. - -.. 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 {{�� 141\�h(VlTh .1'1✓ E�k}S:\— tR nIc_- NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE I2?Y L I �nSlc- (�'1S7)lr,-, /-ve_ .5,ryr,<0tin � «n )Fl) aN,A pic2a i („ 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 / ( 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 GG.. 'l'�' B �� VB/ C\Jf fY C..J � L C� W -42 9MANUF HOMEAPPL (R/2/02)OR (W)Page 1 of 2