1996, 06-07 Permit App 96003042 MHAUU 1 I/l0 ul-7L/—.DJ.74aO-4
ry T'XO^ WJSNINGTONMANUFACTURED HOME
REGORDEMS CLOCK
AT THE PEOUEST OF:
'iansim APPLICATION
NFILE.AME
NAME
.heck one
WA,TOR r7:ITOPL
TITLE ELIMINATION (Complete all but section 3, below)
1200
RAGUE AVE
TRANSFER IN LOCATION (Complete ALL sections below)
SPOKANE, WA 99206 -5 -
REMOVAL FROM REAL PROPERTY (Complete all but section 4, below)
MANUFACTURED HOME
4TE NUMBER
YEAH
MAKE
WIDTHILENGTH
VEHICLE IDENTIFICATION NUMBER (VIM
1996
HOME BUILDE
S NW EVERGREEN 0156021
1357
LAND
T a copy of the legal description of your land. It can be obtained from your County
PROPERTY TA%PAPCELNUMBEP
;son's office or it may be typed or printed on an Additional Attachment Form (TD -420-732). 45183.0717
factured home will be ® AFFIXED REMOVED
TITLE COMPANY CERTIFICATION
T= nBN SPOKANE COi= SHORT PLAT NO. 102745, ACC17RDING 'Ib PLAT RECURDED IN
VOU PE 12 OF SHORT PLATS, PACE 51, IN SPOKANE CUUDTPy, M%SHIDMW.
nalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs.
BUILDING PERMIT OFFICE CERTIFICA77ON
fy that the manufactured home has been affixed to the real as described, building
BLDG PERMIT
property or a
t has been issued for this purpose7 and the attachment will be inspected upon completion.
4130
SIGNATURE/TITLE BLDG
PERMIT OFFICE/PHONEY
DATE
X SPOKANE COUNTY PERMIT CENTER
4,�—,(p
OWNS FORMA ON
FEES
YI NC UNINC I REGISTERED OWNERS . LEGAL OWNERS Provide the Washington Driver's License or I.D.
FILINGFEE
❑ ® 1 1 card number (PIC) for each owner:
AME OF FIRST OWNERAPPLICATION
LINDA NYE
AME OF SECOND OWNER
MOBILE HOME FEES
)DRESS OF OWNER
ELIMINATION
321 N DICK RD
--OR-- if the owner is a business,
provide the Unified Business
,TY
STATE
ZIP CODE
USE TAX
SPOKANE
WA
99212
Identifier (UBI), found on the
business Registration & Licenses
Document.
LAME OF FIRST LEGAL OWNER-
SUBAGENT FEES
WASHINGTON MUTUAL BANK
578049326-7
AALING ADDRESS OF FIRST LEGAL OWNER
L 2005 E SPRAGUE AVE SECOND FLOOR
More than two owners or one
TOTAL FEES &TAX
lienholder? Please use attachment
form(s) #TU -420-732.
:fn'
STATE
ZIP CODE
SPOKANE
WA
99206DEALER'S
I
REPORT OF SALE
I certify that this information is correct. The vehicle is clear
IGNATURE OF LEGAL OWNS CATES CONSENT TITLE/REMOVAL
=ROM REAL PROPERTY:
of encumbrances except as shown.
Nho knowingly makes a false statement of a material (alit is guilty of a , and WA DLR NO. DATE OF SALE PURCHASE PRICE
wiction may be punished by a fine of up to S5.Doo and/or 10 years imprisonment 4088 7-22-96 58,424.0
6.12210). 1 DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY LAW
DEALER NAME TAX JURISDIcilowrAx PATE
VE ARE THE REGISTERED OWNERS OF THIS VEHICLE AND THIS INFORMA-
ACC ATE: 0w Sig--(.(YThl.(.): Dye ley Homes42 8.1%
TURE
=A )ZED SIGNAIF
I
USE TAX EXEMPT Sale to a Certified Tribal member on
'Ihe reservation (anach notarized statement of delivery)
TRL NSE AGE a EP LQ.QWCRIBED TO AND WOPNBEFOREME THIS
Residingin(Counlyl
/
DAV OF
COUNTY AUDITORIA GENT LICENSING OFFICE APPROVAL. (Not for use by Sub -Agents)
y that the above application appears to have been completed correctly, and the applicant 11curraMon
to
A with the recording of this form.
SIGNATURE OFFICENFS
OPERATOR NUMBER
DATE
X
'!D FL
84