2005, 07-05 Title EliminationRETURN ADDRESS
- State Wide Escrow, LLC
- 720 North Argonne Road, Suite C
- Spokane, WA 99212
5 S3
MANUFACTURED HOME PLEASE CHECK ONE
L1SDTATEOFWASHWGTON
YY mrn r
/CEI1S11IG APPLICATION
❑ TITLE ELIMINATION
EITRANSFER 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)
0 MANUFACTURED HOME
TPO / PLATE NUMBER
YEAR
2005
MAKE
NASHUA
LENGTHANIDTH(FEET)
48 X 26
VEHICLE IDENTIFICATION NUMBER(VIM)
2 LAND LEGAL DESCRIPTION ON PAGE
MANUFACTURED HOME WILL BE Q AFFIXED D REMOVED
REAL PROPERTY TAX PARCEL NUMBER
45334.0408
LOT
4, 5, & 6
BLOCK
3
PLAT NAME OR SECTION/TOWNSHIP/RANGE
HATHERLY'S SUBDIVISION
QUARTER/QUARTER SECTION
3
GRANTOR(S) REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE
COUNTY NUMBER
SPOKANE
NUMBER OF REGISTERED OWNERS
2
NUMBER OF LEGAL OWNERS
1
NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
James T. Johnson
NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
Harriet E. Johnson
ADDRESS CITY STATE ZIP CODE
4212 South Hatherly Circle Spokane Valley WA 99206
NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
Numerica Credit Union
NAME OF ADDFONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
ADDRESS CITY STATE ZIP CODE
301 North Havana Street Spokane WA 99202
GRANTEE
NAME
James T. Johnson and Harriet E. Johnson
I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT I / WE AM/ARE THE REGISTERED OWNER(S) OF THIS
VEHICLE AND THIS INFORMATION IS ACCURATE:
Signature of Registered Owner and Title, IF APPLICABLE ,nl—ig
fi97,-C/'J-7--
I r c n
Signature of Additional Registe ed Owner and Title, IF APPLICABLE % e - d-1 ins -11...._
NOTARY SEAL OR STAMP
^^^^^^^^.....,.,
NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER(S) SIGNATURE
State of Washington / Signed or attested
County of �.nbkCtA.0 before me on -3-l! (0 5-
SHEILA M. REIMER
NOTARY PUBLIC
STATE OF WASHINGTON
COMMISSION EXPIRES
Autust 15, 2008
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by ttncPA
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, P� NAMEOFREGISTE REGISTERED
by ,i.J2.i E t t '-—A-(
M
ARYORAGENT
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c i1hs(n__ ‘ N Y� �.e ,2%.�,�
PRRiYNT NAME OF REGISTERED
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Title {' n �-
OWNER PRINTEDED NAMEOF NOTARY
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County/effiee-NesaR
�(N� �— AND:-DealeH4cOR /5(e d
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Notary Expiration Date
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.
5 BUILDING PERMIT OFFICE CERTIFICATION
I certify that: CI the manufactured home has been affixed to the real property as described.
CI a building permit has been issued for this purpose and the attachment wil be inspected upon completion.
NAME (TYPED OR PRINTED) BLDG PERMIT OFFICE/PHONE a
5 \: V\\\ 11; X-C`O-)r)
BLDG PERMIT It
05- ISO
SIGNATU�RE/
I.
PO5ITION
..(
!
_ DATE
ll� a 3LJ9C (? � Ire-1T
rrur name Arrl (wllup)OH (w)vage t o
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0 SIGNATURE OF LEGAL OWNER
SIGNATURE OF LEGAL OWNER INDICATES CONSENT FOR ELIMI ATION / REMOVALJFROM REAL PROPERTY.
Signature of Legal Owner and Title, IF APPLICABLE
.
Signature of Additional Legal Owner and Title, IF APPLICABLE
NOTARY SEALOR STAMP I NOTARIZATION/CERTIFICATION FOR LEGAL OWNER(S) SIGNATURE
I State of Washington Signed or attested
County of SP G? 1tCi --ht- befforee me on 1 S) L5
— - — — _
by
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PI &41eL) i ,r ts(tcme✓ica-. Signatur4 di^: f� �f... l �lAt�i'
hj
NotaryPubfc I
State of Washington I by
HOW ANDERSON
INTNAME0PLEGAcL-OWNER Cr--1-1,(J1ty'\ T RYORAGENT
1 bid / / t' 4. ){' S 6'r\
I FilINT
F pointment Expires Jan 19, 2008
Title'
NAME OF LEGAL OWNER PRINTED NAME OF NOTARY
County/Office No. OR i
AND: Dealer No. OR i l f` t omIllimellripmurepmenripperacAi
LERSHIPPOSmOWAGENT/NOTARY Notary Expiration Date
DLAND DESCRIPTION (A legal description of the land can be obtained from the local County Assessor's
Lots 4, 5, and 6 in Block 3 of HATHERLY'S SUBDIVISION as per plat thereof recorded in Volume 7 of Plats,
page 71;
Situate in the County of Spokane, State of Washington.
0 DEALERS REPORT OF SALE
I CERTIFY THAT THIS INFORMATION IS CORRECT. THE VEHICLE IS CLEAR OF ENCUMBRANCES EXCEPT AS SHOWN.
ANY REQUIRED SALES TAX HAS BEEN COLLECTED.
DEALER NAME (TYPED OR PRINTS
Pe 4 / .cG , t/L,i-k :T�- .
WA DEALER NUMBER
I/ &
DATEOFSALE
5,-/.5: o a�
PURCHASE PRICE
s APSnfoo
TAXJURISDICTIOWTAX RATE
Spoke-c¢ K,,o_�c.�
D rS HO ZED SIGNATURE , // `
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® USE TAX EXEMPT Sale to a Certified Tribal memb r on the reservation (attach notarized statement of delivery).
9
COUNTY AUDITOR/AGENT LICENSING OFFICE APPROVAL (Not for use by Subagents)
1 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 (TYPED OR PRINTED)
COUNTY OFFICENFS OPERATOR NUMBER
SIGNATURE
DATE
10
TITLE FEES
FIUNG FEE
APPUCATION
MOBILE HOME FEE
ELIMINATION FEE
USETAX
SUBAGENTFEES
TOTAL FEES B 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 service 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 Horne Application Instructions.
The Department of Licensing has a policy of providing equal access to its services.
11 you need special accommodation, please cal (360) 902-3600 or TTY (360) 664-8885.
TO-420-729 MANUF HOME APPL(R/2/00)OR (W)Page2of2