HomeMy WebLinkAboutMFG Home - BLD Application - 1/25/2007 RECEIVED
RETURN ADDRESS 'AN 2 5 2007
Land Title Escrow MASON COUNTY
30 NE Romance Hill Rd #103/P.O. Box 1920
Belfair, WA 98528
Order No.: rn 1 <� LI ��.-)-- 1 t;,
Lh�Z).�,t p�w;SH1NGW MANUFACTURED HOME
LL77// APPLICATION TITLE ELIMINATION
ICEBShIG ®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 I PLATE NUMBER YEAR MAKE LENGTR WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN)
%7 6 8 3 3 1983 Kentwood 60 X 14 W 10077
LAND LEGAL DESCRIPTION ON PAGE
TAX
MANUFACTURED HOME WILL BE ® AFFIXED R PERARCEL NUMBER
❑ REMOVED 1 2332330 51 0000012
LOT BLOCK PLAT NAME OR SECTIOWTOWNSHIP/RANGE 7 QUARTERQUARTER SECTION
12 '
GRANTOR(S)REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE
COUNTY NUMBER NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS
1 1
NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
Barbara E. Langland
NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
ADDRESS CITY STATE ZIP CODE
50 NE Galley Way, Belfair, WA 98528
NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
Sound Community Bank
NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
ADDRESS CITY STATE ZIP CODE
10200 East Marginal Way South, Seattle, WA 98168
GRANTEE
NAME
I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT I/WE AM/ARE THE REGISTEREq O NER(S)OF THIS
VEHICLE AND THIS INFORMATION IS ACCURATE: /
Signature of Registered Owner and Title, IF APPLICABLE
SignatQFk Of Aqq itional Registered Owner and Tide,IF APPLICABLE
TAMP NOTAR17ATIONICERTIFICATION FOR REGISTERED OWNER(S)SIGNATURE
l /`► //// State of Washington Signed or attested
Vwo '�,�iOY County of I before me on CI Lc._
sa` A.~ Go; 2 by Barbara E. Langland Signature V LO--
j i y PRINT NAME OF REGISTERED OWNER ( NOTARY OR AGENT
by
PRINT NAME OF REGISTERED OWNER PRINTED NAME OF NOTARY
`STATE `� Y� 11-� County/OfficeDoctor No.OR _ �v
.�,,.,. Csalar No.OR
f i DEALERSHIP POS N/AGENTMOTARY Notary Expiration Date
T(yLTabUP,ANY 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 I POSITION DATE
Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs.
BUILDING PERMIT OFFICE CERTIFICATION
I Certify that: 11the manufactured home has been affixed to the real property as described,
a a building permit has been issued for this purpose and the attachment will be inspected upon completion.
NAME(TYPED OR PRINTED)' 'y BLDG PERMIT OFFICEIPHON91 BLDG PERMIT N
J 4 i
+ 1...
SIG NAT RE!POSIT ION; DATE
ZA
TD-t 29MANUFHO4,EAPPL(RW2)OM)P4e11Of r