1992, 01-22 MH Page 2Manufactured Home:
Year 78 Make
Vehicle Identification Number
Registered Owners:
Names
Legal Ow rs:
Names
I 1177v%Le- Width / 7 Length 7D
KO-/zSn:Yi—'/9
Signatures' 4 _ ® . \
Signatures' A, O a _ R. 4 w
'SIGNATURES OF OWNERS INDICATE TER ATION OF INTEREST IN THE MANUFACTURED HOME THROUGH TITLE PROVIDED BY CHAPTER 46.12 RCW AND
INDICATE INTENT TO PERFECT INTEREST IN THE MANUFACTURED HOME AS REAL PROPERTY WITH THE LAND HE/SHE/THEY OWN AND TO WHICH IT IS/IS
BEING AFFIXED.
Land to Which Manufactured Home is Being Affixed:
Property Tax Parcel Number I/VIMa2Pi3
Legal Description .got 13 &4L %r /'izeG ,
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Owners' Names i 4l'iee YG7oexe,{ ..,tS
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2SIGNATURES OF OWNERS INDICATE CONSENT TO HAVE THE MANUFACTURED HOME ADDED TO THE REAL PROPERTY LISTED ABOVE.
Building Permit Office Certification:
I certify that the manufactured home has been affixed to the real property, as described above and/or building permit
number DO coo has been issued for the purpose of affixing the manufactured home to the land and will be
inspected upon completion. SPOKANE COUNTY
, n
BUILDING & SAFETY
NAME
lel
SIGNATURE
BLDG. PERMIT OFFICE
DATE
as-907 sca—,3 25—
PHONE NUMBER
County Auditor/Agent Licensing Office Approval: (Not for use by subagents)
I certify that the above application appears to have been completed correctly, and that the applicant has sufficient
documentation to proceed with the recording of this form.
NAME
SIGNATURE
OFFICE/CAAP OPERATOR NUMBER
DATE
Recording Office:
I certify that this form has been recorded in the county records.
NAME
SIGNATURE COUNTY
DATE RECORDING NUMBER
Note: Every person who falsifies or intentionally omits material information required in an affidavit is guilty of a gross
misdemeanor punishabie in accordance with RCW 9A.20.021.
TD.420.730 MFG HOME TITLE ELIM IN/1/901 Page 2 of 2