2010, 11-17 Manufactured Home App 10-3959 Title EliminationAFTER RECORDING MAIL TO:
First American Ttile
40
Filed for Record at Request of: Space above this line for Recorders use only
First American Title Insurance Company
MANUFACTURED HOME PLEASECHECKONE
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'•,, .,,, { ' APPLICATION X TITLE ELIMINATION
110Ensinc TRANSFER IN LOCATION
Anyone who knowingly makes a false statement of a material fact is guilty ❑ REMOVAL FROM REAL PROPERTY
of a felon and upon conviction may be punished b a fine imprisonment, or both. RCW 46.12.210
MANUFACTURED HOME
TPO/PLATE NUMBER
MAKE
LENGTH/WIDTH (FEET)
VEHICLE IDENTIFICATION NUMBER (VIN)
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8
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LAND LEGAL DESCRIPTION ON PAGE 2
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MANUFACTURED HOME WILL BE AFFIXED ❑ REMOVED
REAL PROPERTY TAX PARCEL NUMBER
45181.1034
LOT
3
BLOCK 2
PLAT NAME ORS CFION/TOWNSHI /RAN E
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OUARTER/OUARTER SECTION
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GRANTOR(S) REGISTERED/ LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE
COUNTY NUMBER
NUMBER OF REGISTERED OWNERS
NUMBER OF LEGAL OWNERS
TDO148
NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
Jim D. EllardLl
NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
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NA Fs OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
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NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
ADDRESS CITY STATE ZIP CODE
GRANTEE
NAME
Jim D. Ellard
I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT I/ E AM/ARE THE REGISTERED OWNER(S) OF
THIS VEHICLE AND THIS INFORMATION IS ACCURATE:
Signature of Registered Owner and Title, IF APPLICABLE
Af nal Registered Owner and Title, IF APPLICABLE
NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER(S) SIGNATURE
i State of Washington Signed or attested
1 Spokane before Z
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: County of me on
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NOTARY
by Jim D. Ellard Signature — —
Z 1 PRINT NAME OF REGISTERED OWNER NOTARY OR A ENT )�
N PUBLIC
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'•'9,0 :` I PRINT NAME OF REGISTERED OWNER PRINTED NAME OF NOTARY
L�I County/Office No. OR 4
0 1 Title Notary AND Dealer No. OR �
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1 DEA ERS POSITION/AGENT/NOTARY -- ` Notary Expiration Date
TITLE COMPANY CERT IF , TION
I certify that the legal descrip '6h of the land and ownership is true and correct per they eal property records.
NAME (TYPED ORPRINTED) ,) ���'����/y�j�j,•/Z TITLE SAMPANY/PHONE NUMBER
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r First r melican Title Insurance Company ,.'.--•••(509)456-0550
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SIGNATURE/POSITION �j �L/ r.'�[;y j=,�F�"Zj�� — -- DATE11h.1,
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Finalize this application with a Licensing Agent wi •6in 10 cfiitendar days of the date Title Company Representative signs.
BUILDING PERMIT OFFICE CERTIFICATION
Q, 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.
N/ (TYPED ORP TED) BLDG PERMIT OFFICE/PHONE #
BLDG PERRMIIT, #
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`SiGNA RE/POSITION DATE
MANUF HOME PPL(R/2/02)011 (W)Page of 1 First American Title File No. 4253-450107 (SH)
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