2011, 01-10 Title EliminationRETURN ADDRESS
Victor F. Gilica and Patricia A. Gilica
17915 East Indiana Avenue
Spokane Valley, WA 99016
STATE OF PLEASE CHECK ONE
MANUFACTURED HOME
WASHINGTON X TITLE ELIMINATION
Department of Licensing APPLICATION
Escrow No. 00024365-551-KT 0 TRANSFER IN LOCATION
Anyone who knowingly makes a false statement of a material fact is guilty of a0 REMOVAL FROM REAL PROPERTY
felony, and upon conviction may be punished by a fine, imprisonment, or both.
(RCW 46.12.210)
1 MANUFACTURED HOME
TPO/PLATE NUMBER
YEAR
2010
MAKE
55LCR28523
CH10
LENGTH/WIDE(FEET)
52 X 30
VEHICLE IDENTIFICATION NUMBER (VIN)
HER027343OR -
2
LAND LEGAL DESCRIPTION ON PAGE
MANUFACTURED HOME WILL BE X AFFIXED o REMOVED
REAL PROPERTY TAX PARCEL NUMBER
55074.0516
LOT 6BLOCK
FIAT NA OB SECTIQU/TOW HIp(RANGE
QUARTER/QUARTER SECTION
GRANTORS) REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE _
COUNTY NUMBER
NUMBER OF REGISTERED OWNERS
2
NUMBER OF LEGAL OWNERS
1
NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
Gilica, Victor F.
NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
Gilica, Patricia A.
ADDRESS CITY STATE ZIP CODE
17915 E Indiana Avenue Spokane Valley WA 99016
NAME OF REGISTERED LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
Horizon Credit Union
NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
ADDRESS CITY STATE ZIP CODE
13224 E Mansfield Ave #300 Spokane Valley WA 99216
GRANTEE
NAME
Victor F. Gilica and Patricia A. Gilica, husband and wife
I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT trysig,IttiA E THE GTS ER D OW E ) OF THIS
VEHICLE AND THE INFORMATION IS ACCURATE: (L—
)
Signature of Registered Owner and Title, IF APPLICABLE / l v ' Uf
•
Signature of Additional Registered Owner and Title, IF APPLICABLE r�l LCG'll**'L(-
NOTARY S Ut41ETtQ;IN�P�
���� ��TAUSC"//
•' ",<SSiOD ' •• y<f`
NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER(S) SIGNATURE
tate of Washington Signed or attested /
"i" County of Spokane before me on ~r 0
`.�� �.P�
C� Fa •. '7
b 1-'. •.
BY
C I Dr t toy (' ,, Signatu
:'U� O �A
_ N Ry t
° �
r,
i R NT NAME OF REGISSTEFtE6 OWNER N ARY OR AG
BY = �LX I- 1 '1. k vt M 1 61 , ! 1 (. - ti '_
• PUBLIC i
Nj, •
'9j •B 16 \ t,' .t0�
mRINT NAME OF REGISTERED OWNER T D NAME OF NO A Y
County Office No. OR tp _ 4
LE A b V1,4 ‘_ AND: Dealer No. OR
�i�, �() '' �" ��
N DEALERSHIP POSITION/A NT/NOTARY Notary Expiration Date
4
TITe po t �l
TIFICATION
�f
I certify that the/ledhl Vegcription 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
X the manufactured home has been affixed to the real property as described.
1 certify that:: 0 a building permit has been issued for this purpose and the attachment will be inspected upon
completion.
NAME (TYPED OR PRINTED)
i'24'ht)- . G i�
BLDG PERMIT OFFICE/PHONE #
��q- _ �2 (`C�
l >� !
BLDG PERMIT #
10000556
SIGNATURE/POSITION "A
VIf7rs0'pPs\( 1.t- CF V
DATE
A VVA
29MANUF HOME APPL(R/ 2)OR )Page 1 of 2 Manufac1uretl Home Applicau