2009, 09-29 Title EliminationStatc
GR
MY
RETURN ADDRESS
L AS CH CKON
dWASHINGTON
Anyone
of a
Manufactured Home
SLATE DEPARTMENT OF [TITLE ELIMINATION
LICENSING Application •TRANSFER IN LOCATION
•
who knowingly makes a false statement of a material fact Is guilty 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
+388860
YEAR
2006
MAKE
LIBER
LENGTH/WIDTH(FEET)
40 X 28
VEHICLE IDENTIFICATION NUMBER (VIN)
09L35480XU
bLAND LEGAL DESCRIPTION ON PAGE
MANUFACTURED HOME WILL BE L"AFFIXED • REMOVED
REAL PROPERTY TAX PARCEL NUMBER
45172.1429
LOT
1
BLOCK
PLAT NAME OR SECTION/TOWNSHIP/RANGE
Short Plat SHP 42-06
QUARTER/QUARTER SECTION
3
GRANTOR(S) REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE
COUNTY NUMBER
NUMBER OF REGISTERED OWNERS
NUMBER OF LEGAL OWNERS
NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NJMBER
R. Terry Neal
NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
Terry D. Neal
ADDRESS CITY STATE ZIP CODE
4204 South Sunderland Drive Spokane Valley WA 99206
NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
Panhandle State Bank
NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
ADDRESS CITY STATE ZIP CODE
P.O. Box 2559 Coeur d' Alene ID 83816
GRANTEE
NAME
I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT I / WE A E THE REGI TERE OW (S) OF THIS
VEHICLE AND THIS INFORMATION IS ACCURATE:
Signature of Registered Owner and Title, IF APPLICABLE
Signature of Additional Registered Owner and Title, IF APPLICA E
NOTARY SEAL OR STAMP 1 NOTARIZATION/CERTIFICATION FOR ISTERED OWNE (4) SIGNA
1 State of Washington Signed or attester
Cti*-¢ i t\
•mcsakt,
County of (.> .: •or: •Cf
otary Public
of Washington
by C �� `4 Ci1 Signatu
I .►�
� ���,.,�1.
ETA EBRECHT
EXPIRES
PRINT NAME OF REGISTERED OWNER ��T ' .. n 4% I_ q.
by �(1I_CLOQ�Q-fr b.NKS C U`ti2ci�'
MMISSION
July 25, 2012
PRINT NA OF RE 'STEREO OWNER J PRINTED NAME OrNOTARY
(� C unty/Office No. OR
Title 0`)OT(34 AND: Dealer No. OR 01pe924P,
DEALERSHIP POSITI /AGENT/NOTARY ,totary Expiration Date
4
TITLE COMPANY CERTIFICATION
I certify that the legal description of the land and ownership is true and correct per the real rFoperty records.
NAME (TYPED OR PRINTED) TITLE COMPANY / PHON= ,4UMBER
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: )M,the manufactured home has been affixed to the real rruperty as described.
0 a building permit has been issued for this purpose ' J the attachment will be inspected upon completion.
NA E (TYPED OR PRINTED) BLDG PERMIT OFFICE/PHO' - R
no.. akiii t.S 509 Q? 1-1 nom° .6 '- 003(p
BLDG PERMIT N
07003893
SIG TURF /_POST N ` ` DA E
nrvv ). 'cP -C- t t}- 9 /15169
TO-
29 (R/B/06)
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1