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2008, 05-15 Title Eliminationstewart title of spokane 11917 E. Broadway Ave., Suite 102 Spokane Valley, WA 99206 Phone (509) 927-7171 — Fax (509) 927-3393 May 15, 2008 City of Spokane Valley Attn: Permit Department 11703 East Sprague Here is an Manufactured Home Elimination form for 17318 E 4`h Avenue, Spokane Valley, WA 99016. I have been told that the final inspection has been done so the title can be eliminated. After the Building Permit Office Certification has been signed, please give me a call at the above number and I will send someone to pick it up. If you have any questions or concerns, please call me. Thanks for your assistance. Sincerely, Stewart Title of Spokane Laura J. Biddle Limited Practice Officer RETURN ADDRESS ctWASHINGTON STATE DEPARTMENT OF Manufactured Home LICENSING Application Anyone who knowingly makes a false statement of a material fact is of a felony, and upon conviction may be punished by a fine, imprisonment, [TITLE REMOVAL (RCW PLEASE CHECK ONE ELIMINATION IN LOCATION FROM REAL PROPERTY 46.12.210) ■TRANSFER • guilty or both. 1 MANUFACTURED HOME TPO / PLATE NUMBER YEAR 1985 MAKE GUER LENGTH/WIDTH(FEET) 52 X 28 VEHICLE IDENTIFICATION NUMBER (VIN) 11420 2 LAND LEGAL DESCRIPTION ON PAGE MANUFACTURED HOME WILL BE [AFFIXED REAL PROPERTY TAX PARCEL NUMBER 55192.1407 • REMOVED LOT 70,000.00 BLOCK 3 PLAT NAME OR SECTION/TOWNSHIP/RANGE Apple Valley Estates 1st Addition QUARTER/QUARTER SECTION Q GRANTOR(S) REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE COUNTY NUMBER NUMBER OF REGISTERED OWNERS 'y NUMBER OF LEGAL OWNERS 2 NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER Charles H. Stone NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER Ruth V Stone ADDRESS CITY STATE ZIP CODE PO Box 141928 Spokane WA 99214 NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER Same as registered owner NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE GRANTEE NAME I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY VEHICLE AND THIS INFORMATION IS ACCURATE: Signature of Registered Owner and Title, IF Signature of Additional Registered Owner and Title, IF THAT I / WE AM/ARE THE REGISTERED OWNER(S) OF THIS APPLICABLE APPLICABLE . NOTARY SEAL OR STAMP State by by Title NOTARIZATION/CERTIFICATION of Washington County of FOR REGISTERED Signed or before OWNER(S) SIGNATURE attested me on Signature PRINT NAME OF REGISTERED OWNER NOTARY OR AGENT PRINT NAME OF REGISTERED OWNER PRINTED NAME OF County/Office AND: Notary NOTARY No. OR Dealer No. OR DEALERSHIP POSITION/AGENT/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 certify that: El the 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/PHONE # BLDG PERMIT # SIGNATURE / POSITION DATE TD-420-729 (R/6/06) W Page 1 of 2 MANUFACTURED HOME - FROM SECTION 1 TPO / PLATE NUMBER YEAR 1985 MAKE GUER LENGTHANIDTH(FEET) 52 X 28 VEHICLE IDENTIFICATION NUMBER (VIN) 11420 6 SIGNATURE OF LEGAL OWNER SIGNATURE OF LEGAL OWNER INDICATES CONSENT FOR ELIMINATION OF TITLE / REMOVAL FROM REAL PROPERTY. Signature of Legal Owner and Title, IF APPLICABLE Signature of Additional Legal Owner and Title, IF APPLICABLE NOTARY SEAL OR STAMP NOTARIZATION/CERTIFICATION FOR LEGAL OWNER(S) SIGNATURE State of Washington Signed or attested County of before me on by Signature PRINT NAME OF LEGAL OWNER NOTARY OR AGENT by PRINT NAME OF LEGAL OWNER PRINTED NAME OF NOTARY County/Office No. OR Title AND: Dealer No. OR DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Date 7 LAND DESCRIPTION (A legal description of the land can be obtained from the local County Assessor's Office) Lot 7, Block 3, Apple Valley Estate First Addition, according to the plat thereof recorded in Volume 11 of Plats, Pages(s) 58, records of Spokane County, Washington. Situate in the County of Spokane, State of Washington. 8 DEALER'S 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 PRINTED) WA DEALER NUMBER DATE OF SALE PURCHASE PRICE TAX JURISDICTION/TAX RATE DEALERS AUTHORIZED SIGNATURE U USE TAX EXEMPT Sale to a Certified Tribal member on the reservation (attach notarized statement of delivery). 9 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 10 TITLE FEES FILING FEE APPLICATION MOBILE HOME FEE ELIMINATION FEE USE TAX SUBAGENT FEES MPORTANT: Once the application has been approved by the County Audtor / Vehicle TOTAL FEES & TAX 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 Horne 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. TO-420-729 (R/6/06) W Page 2 of 2