1995, 09-21 Manufactured Home App STATE OF WASHINGTON RECORDER'S CLOCK FILED AT THE REQUEST OF:
4 o:arfinentoJ _ MANUFACTURED HOME
lICEnSInG APPLICATION NAME
Please check one
ADDRESS
xx 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)
Q MANUFACTURED HOME •
TPO/PLATE NUMBER YEAR MAKE WIDTH/LENGTH VEHICLE IDENTIFICATION NUMBER(VIN)
&53104 87 BRFLD 60/56 x 28 DFLBF2AH151309989
El LAND
Attach a copy of the legal description of your land. It can be obtained from your County
Assessor's office or it may be typed or printed on an Additional Attachment Form (TD-420-732). PROPERTY 2539ELNUMBER
Manufactured home will be n AFFIXED REMOVED 55173.25
El 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 certify that the manufactured home has been affixed to the real property as described, or a building BLDG PERMIT if
pe mit has been js ed for this purpose and the attachment will be inspected upon completion. $7d03��
NA /
SIGNATURE/TITLE BLDG PERMIT OFFICE/PHONE# DATE
�/ (;� r �'�j/r/J X SPOKANE COUNTY n _ /I /�/
�` 'N D�(nN nF BUILDING AND PLANNING r-1�,�1 i /� .-�� J /lam /�
Ili, OWNER INFORMATION J / �LES
COUNTY# INC UNINC #REGISTERED OWNERS #LEGAL OWNERS Provide the Washington Driver's License or I.D. FILING FEE tt
1111 card number(PIC)for each owner:
NAME OF FIRST OWNER
R APPLICATION
E Clement W. Gornall
a NAME OF SECOND OWNER
t • MOBILE HOME FEES
S
Zella M. Gornall
E ADDRESS OF OWNER I
R ELIMINATION
E 19310 East Dove Circle OR -if the owner is a business,
D CITY STATE ZIP CODE provide the Unified Business USE TAX
Identifier(UBI),found on the
Gr_e_enacres WA 99016 business Registration&Licenses
NAME OF FIRST LEGAL OWNER' (�O Document. SUB-AGENT FEES
L 77 / z aa�c� D1 C�I'l�d
t A TT t
E MAILING ADDRESS OF FIRST LEGAL OWNER
N
More than two owners or one TOTAL FEES&TAX
H 14523 East Trent Avenue
LCIS lienholder? Please use attachment
STATE ZIP CODE form(s) #TD-420-732. I
E Spokane 99215 DEALER'S REPORT OF SALE
•
R SIGNATURE OF LEGAL OWNE D ATEONSEN 0 LIMINATI N OF TIT /RE
t2 c� ret.,-- , //�, � I certify that this information is correct. The vehicle is clear
FROM REAL PROPERTY: P At'/ of encumbrances except as shown.
Anyone who knowingly makes a false statement of a material fact is guilty of a felony,and A litdSALE
WA DLR NO. � PURCHASE PRICE
upon conviction may be punished by a fine of up to$5,000 and/or 10 years imprisonment 1 1111t1 1 �
(RCW 46.12.210). I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY LAW 11:11111111111
THAT I/WE ARE THE REGISTERED OWNERS OF THIS VEHICLE AND THIS INF (lq11 to g 9 MFt 5r ak TAX JURISDICTION/TAX RATE
TION ISIICCURATE: Owner Signature(e)8 Ti Of i
G ������ WA1,l)O t0,�
//_ // 7 // 9 y/�
X 1:7� r„..."l,l 2. (S`- z„..,-,e i:Ii)V p� vvTt tp S%Np i UNE
X � J - iNO i�i Cpt1NSY ors k GU`-.'
1
CrojAStDN Ew u1.
1111111111111�TAX EXEMPT Sale to a Certified Tribal member on
NOTARY O,R ICEN�E AG T 8 fV(1 BER 1111111/1/ the reservation (attach notarized statement of delivery)
�� SUBSCRIBED TOtl1Ti SWORN BEFORE ME THIS Residing in(County)
X �,„e ,A,t, dr.,0 iL��. / DAY OF S V 1916_ -
COUNTY AUDITOR/AGENT LICENSING OFFICE APPROVAL:(Not for use by Sub-Agents)
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 SIGNATURE OFFICENFS OPERATOR NUMBER DATE
X
•
TD-420-729 MANUF HOME APPL(R/2/94)M Page 1 of 2