2011, 08-06 MH Title EliminationRETURN ADDRESS
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, STATfishalZfASHINGTON
ICEnSin
MANUFACTURED HOME
►:TITLE
APPLICATION DTRANSFER
statement of a material fact is guilty REMOVAL
be punished by a fine, Imprisonment, or both. (RCW
®igiriniv rrareMil
ELIMINATION
IN LOCATION
FROM REAL PROPERTY
46.12.210)
Anyone who knowingly makes a false
of a felony, and upon conviction may
MANUFACTURED HOME
TPO / PLATE NUMBER
aestin.
YEAR
Ic-t.S
MAKE
cer�?r(�
LENGTHAVIDTH(FEET)
6 x /�f
VEHICLE IDENTIFICATION NUMBER (VIN)
11)�fi159�St5' �'L-15.
LAND `/ LEGAL DESCRIPTION ON PAGE .
MANUFACTURED HOME WILL BE ,AFFIXED
REAL P PEEO T PAROEL Nf4
• REMOVED
LOT
BLOCK
Pkn1 E,
PLAT NAME
6;ree_inorms rrr;c�-t in
SECTION/TOWNSHIP/RANGE
GRANTOR(S)REGISTERED/LEGALOWNER(S) ADDITIONALNAMESONPAGE
COUNTY NUMBER
NUMBER OF REGISTERED OWNERS
eQ
NUMBER OF LEGAL OWNERS
NAME OF REGISTERED OWNER
�OF` �1 r .
NAME`/OF REGIb fEREO ER
AODRI
`.) f` t c- ..V) Y� I I
ADDRESS
1-7 P 4 ,Kw-drh
7DrP
CITY STATE ZIP CODE
P-AL 6 freenacrs Lc Pr. 99,/,
--Flora.
NAME OF LEGAL OWNER
Nene: n e_ Ki J9ore�
NAME OF ADDITIONAL LEGAL OWNER
6u Min K;176re_•
ADDRESS CITY STATE ZIP CODE
l `7 /4 Akir-1-n F/,r& 4910°1_ cr.00.viahr C u Ifs 9 )k
GRANTEE
NAME ��^^ �/ ,_
.bcoCiF1Q , Ki fry re_ ant c�LLS f C�..I (Dore l-i7j g1 i 4. (,t)$ F `e
1 DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY
VEHICLE AND THIS INFORMATION IS ACCURATE:
Signature of Registered Owner and Title, IF
Signature of Additional Registered Ownerand Title, IF
THAT I / WEAM/ARE THIN REGISTERED OWNER(S) OF THIS
...'.
APPLICABLE` f,7 .,, r-� K._ (Sf
l
APPLICABLE � - -yr? < - % e4CS.�
NO \ARCI�� GR('yWP I
s�``��NO kg --. �,nt rp'�4: I StateofWashington
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PUBLIC
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///��i�aF WAS\j� G�,,,--tI-ri<fe^-
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NOTARIZATIOWCERTIFICATION
County of
.IL) LA\ane_
FOR REGISTERED
I Signed
c 1A. - ! '
or attested
before
_lure
OWNER(S)SIGNATURE
me on /f�//
, I�f(il`"'e_
-
. rXdf s!,i.
OF REGI ERED NER NO •R
FRINT�- SO Sri_
X`147 -/ e U
o'".2nT
r Pi rr)e-H-C-
PRINT NAME OF REGISTERED • NER PRINTED
��N/
NAME
County/Office
AND:
Notary
NOTARY
No: oR
Dealer No. OR
DEALERSHIP POSITION/ OTARY -
Expiration Date 9,7,1/,(
.TITLE COMPANYCERTIFICATION
I certify that the legal description of the land and ownershlp Is true and c rrect per the real property records.
NAME (TYPED OR PRINTED) d 7'y,,.
G>)=.,,
'*,-c„,, ,fro T E
COMPANY / PHONE NUMBER
SIGN URE / POSITION
DATE //% J
a.
Finalize thisapplication wltTi'afce sing Agent within 10 calendar days of the date Title Company Representative signs.
® BUILDING PERMITT,OFFICEC, IFICATION
I Certify that' the manufactured home has been affixed to the real property as described.
' ❑ a building permit has been Issued for this purpose and the attachment will be inspected upon completion.
NAME (TYPED OR PRINTED)��y BLDG PERMIT OFFICE/PHONE X
IRE -P V'I /'t'K (...'_.S\I -.c,c IZO. ¶�' i
BLDG PERMIT #
L 1 0
SIGNATUREI POSITION
if 6' ,-ill
'
z 5 e r r;1 Pc"/z;T 5 I:t' I; a 7 DAT 'f �/
TD-420.729 MANUF HOME APPL (R/8/9B)OR Page 1 of 2
SIGNATURE OF LEGAL OWNER
SIGNATURE OF LEGAL OWNER INDICATES CONSENT FOR LIMINATION OF TITLE/ REMOVAL FROM REAL PROPERTY.
Signature of Legal Owner and Title, IF APPLICABLE-�u/-�-t-/
Signature of Additional Legal Owner and Title, IF APPLICABLE`
FOR Ls
R�
B0 RDF ��''o, I State ofWashOTARingtonZATCIONICERTIFICATION
moo` g�edo attested)SIGNATURE
J: •s(on•EXp•..F Countyof
C J/.IA7 beforemeon
�q..S�� RY
- : o O�PR y �f Y h C re— nature
��
_ PRINT NAME OF LEGAL OWNER NO OR
U
10- .'QC) �y C�I �� %vim
.VAh r
INT NAME OF TED NAE ?�SINOTARY
CounWOffica No. OR
PRINANDMNOaryEDealerN
�grf OF NP5\��\'\ TttpR ERBHIPPOBRIALA ENTMDTARY Deo
LAND DESCRIPTION (A legal description d1he land can be obtained from the local County Assessor's Office
a9, E>,,qp p+ +he- claw (oS few} -here c-�/ Cir Ives
accord °-o P lo+ (2Cnrd e d in On ! tk hal 2
a-}S Pari e- a I ; n C I 0-P 5)o,0 166t ne, Ja I l 1 po rgy
�o�n , IA�QShi �n
DEALEFVS REPORT OF SAL
I CERTIFYTHATTHIS INFORMATION IS CORRECT. THE VEHICLE IS CLEAR OF ENCUMBRANCES EXCEPTAS SHOWN.
ANY REQUIRED SALES TAX HAS BEEN COLLECTED.
DEALER NAME (TYPED OR PRINTED)
WA DEALER NUMBER
DATE OF SALE
PURCHASE PRICE
TAX JURISDICTIDNRA%RATE
DEALER'S AUTHORIZED SIGNATURE
❑USETAXEXEMPT Sale to a Certified Tribal memberon the reservation (attach notarized statement of delivery).
• COUNTY AUDITOR/AGENT LICENSING OFFICE APPROVAL: (Not for use by Subagents)
I certifythatthe aboveappiication appears to havebeen compietedcorrectiy, andthe applicanthas sufficientdocumentation to proceed with
the recording of this form.
NAME (TYPED OR PRINTED)
COUNTY OFFICENFS OPERATOR NUMBER
SIGNATURE
DATE
in TITLE FEES
FILING FEE
APPLICATION
MOBILE HOME FEE
ELIMINATION FEE
USE TAX
SUBAGENT FEES
TOTAL FEES & TAX
IMPORTANT: Once the application has been approved by the County Auditor/ Vehicle
Licensing Office, take your application form to the County Recording Office.
Retain proof of the recording fees paid. If the Recording Office retains
your original application form, obtain a certified copy of the recorded form.
APPLICANTS: Once recorded, you must return to a Vehicle Licensing office to file the
Manufactured Home Application, paying all required fees. Vehicle
licensing subagents charge a kervice fee.
For full instructions on completing this form for Title Elimination, Removal from Real Property
or Transfer in Location, see form TD-420-730, Manufactured Home Application Instructions.
The Department of Licensing has a policy of providing equal access to Its services.
Ifyou need special accommodation, please cal (360) 902-3600 or TDD (360) 664-8885.
TD•420.729 MANUF HOME APPI. (RAWB)OR Page 2 of 2