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2006, 10-17 Title EliminationRETURN ADDRESS SHLNUu N MANUFACTURED HOME poxa:Ixa.., i L41a'titi " APPLICATION ©TITLE ELIMINATION icEnsinc TRANSFER 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) ® MANUFACTURED HOME TPO / PLATE NUMBER YEAR MAKE LENGTH/WIDTH(FEET) x VEHICLE IDENTIFICATION NUMBER (VIN) g LAND LEGAL DESCRIPTION ON PAGE MANUFACTURED HOME WILL BE 14 AFFIXED a REMOVED REAL PROPERTY TAX PARCEL NUMBER 45334.0407 LOT 1, 2 & 3 BLOCK 3 PLAT NAME OR SECTION/TOWNSHIP/RANGE QUARTER/QUARTER SECTION HATHERLY'S SUBDIVISION a GRANTOR(S) REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE COUNTY NUMBER NUMBER OF REGISTERED OWNERS 2 NUMBER OF LEGAL OWNERS 7 NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER STEVEN J. STILES NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER KIMBERLY A. LEWIS-STILES ADDRESS CITY STATE ZIP CODE 4216 SOUTH HATHERLY CIRCLE' SPOKANE VALLEY WA 99206 NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER STEVEN J. STILES NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER KIMBERLY A. LEWIS-STILES ADDRESS CITY STATE ZIP CODE 4216 SOUTH HATHERLY CIRCLE SPOKANE VALLEY WA 99206 GRANTEE NAME I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT 1 / WE AM/ARE THE REGISTERED OWNER(S) OF THIS VEHICLE AND THIS INFORMATION IS ACCURATE: ` / A �`G� yjA Signature4 ' stere 0 F APPLICABLE'y�Qu�,'�b,-f/q—L,i^"y/�C'�[�f/f�F,-.��/ �¢'l,(-('1� Signature oirf ="ro 3 d APPLICABLE ✓ -� /"y��'G� A- ; r 1A� SSIOry �OAt��r — p�0 Rm® �y `pU:� 0�S• 1 �1 F NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER(S) SIGNATURE State of WashinCountyton of c-/-K'N'` ` 1gbefo e me ed 7'CV ©r L Siof %6 b1il= AJ Signatur PRINT NAME OF REGISTERED OWNERNOT R ENT ay�by//CGN//S✓Jr/�G604 PRINTNA ORISTERED OWNER PRINTED NAME OF NO County/Office No. OR Title AND: Dealer No. OR . N. 11/✓ASO. a DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Date 0 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. ® BUILDING PERMIT OFFICE CERTIFICATION certify that: Ifthe manufactured home has been affixed to the real property as described. El a building permit has been issued for this purpose and the attachment will be inspected upon completion. NAME (TYPED OR PRINTED)) BLDG PERMIT OFFICE/PHONEPHNE2 �,� �, 1; R i !1 �1...)% -- crei S-- e� Ca � BLDG PERMIT II ��"" , gal SIG NA E�/P�..�[{QQ'� "'� Y k i &-j Ill g\/f,. };.�LLe-e'i7, I' DATE \ � Fj+_/ill..\..J� r �1�.(� . R/2/00)OR (W)Page 1 of 2 6 SIGNATURE OF LEGAL OWNER SIGNATURE OF LEGAL OWNER INDICATES CONSENT FOR E I INATIO OF TITLE / Signature of Legal Owner and Title, IF APPLICABLE J AL FROM L ROPERTY. Signature of Additiona nd Title, IF APPLICABLE NOTARY SEAL -4 Tpwltk.A;}t/,M . timed OTARIZATION/CERTIFICATION FOR LEGAL OWNER(S) SIGNATURE shington Signed or attested h unty of`Oa`1(tt-YlC' i before me on I' (-aJC O1T� l L I� e e l 2 r 1 k. A TIJICS to -C isi.. �i% t � :4j�q O��p" -"J Ox P A OF LEGA OWNERari OR AGENT 0 D ma/ a it. • A 4'O.-x /'%QIi, lip ME OF LEGAL OWNER PRINTED NAMEOF NOTARY I vIN0 County/Office o.OR 1 f.,r AND: DeaarNo.OR iu J . DEALERSHIP POSmO AGENT/NOTARY Notary Expiration Date g LAND DESCRIPTION (A legal description of the land can be obtained from the local County Assessor's LOTS 1, 2 AND 3 IN BLOCK 3 OF HATHERLY'S SUBDIVISION, AS PER PLAT THEREOF RECORDED IN VOLUME 7 OF PLATS, PAGE 71; SITUATE IN THE CITY OF SPOKANE VALLEY, COUNTY OF SPOKANE, STATE OF WASHINGTON 3 DEALER'S REPORT OF SALE 1 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 PRINTED) MOBILE CORRAL HOMES WA DEALER NUMBER DATEOFSALE PURCHASEPRICE $59,300.00 TAXJURISDICTIOWTAXRATE DEALERSAUTHORIZEDSIGNATURE 0 USE TAX EXEMPT Sale to a Certified Tribal member on the reservation (attach notarized statement of delivery). 0 COUNTY AUDITOR/AGENT LICENSING OFFICE APPROVAL: (Not for use by Subagents) 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 (TYPED OR PRINTED) COUNTY OFFICE/VFS OPERATOR NUMBER SIGNATURE DATE pi TITLE FEES FILINGEEE APPLICATION MOBILE HOME FEE ELIMINATION FEE USETAX SUBAGENT FEES TOTALFEES&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 retum 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 Home Application Instructions. The Department of Licensing has a policy of providing equal access to its services. If you need special accommodation, please cal (360) 902-3600 or TTY (360) 664-8885. TD-420.729 MANUFHOMEAPPL(Rp100)OR (W)Page2 of 2