HomeMy WebLinkAboutMFG Home - BLD Application - 4/6/2005 RETURN ADDRESS
Title Elimination Services
19300 Pecan St. SW #8
Rochester, WA 98579-8570
�j ST4TCpFWAbHINGTON MANUFACTURED HOME
TITLE ELIMINATION
I CEnsinc APPLICATION EITRANSFER 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/PLATE NUMBER YEAR MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN)
o73184 1983 MODULINE 60 X 14 17747
LAND LEGAL DESCRIPTION ON PAGE
REAL PROPERTY TAX PARCEL NUMBER
MANUFACTURED HOME WILL BE Lf AFFIXED P-1 REMOVED 123305200064/3002892
LOT BLOCK PLAT NAME OR SECTION/TOWNSHIP/RANGE QUARTER/QUARTER SECTION
64 BEARD'S COVE NO.5
El GRANTOR(S) REGISTEREWLEGAL OWNER(S) ADDITIONAL NAMES ON PAGE
COUNTY NUMBER NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS
23 MASON 2 1
NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
COLUMBETTI,ROBERT J
NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
COLUMBETTI,PATRICIA A
ADDRESS CITY STATE ZIP CODE
PO BOX 1018 BELFAIR WA 98528
NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
AMERICAN GENERAL HOME EQUITY,INC.
NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
ADDRESS CITY STATE ZIP CODE
4203 WHEATON WAY, STE F-6 BREMERTON WA 98310
GRANTEE
NAME
I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT I/WE AWARE THE REGISTERED OWNER(S)OF THIS
VEHICLE AND THIS INFORMATION IS ACCURATE:
Signature of Registered Owner and Title, IF APPLICABL&-ff`
,Iilr -i
Signature of Additional Registered Owner and Title, IF APPLICABLE __ A
NOTARY SEAL OR STAMP NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER(S)SIGNATURE
SState of Washington Signed or attested E County of before me on
C'�—y 6701 I by Signature
PRINT NAME OF REGISTERED OWNER NOTARY OR AGENT
by
PRINT NAME OF REGISTERED OWNER PRINTED NAME OF NOTARY
County/Office No.OR
Title AND: Dealer No.OR
DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Date
TITLE COMPANY CERTIFICATION
I certify that the legal description of :he 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.
BUILDING PERMIT OFFICE CERTIFICATION
I certify that: he manufactured home has been affixed to the real property as described.
t
a building permit has been issued for this purpose and the attachment will be inspected upon completion.
NA E TYPED OR PRINTED) BLDG PERMIT OFFICE/PHONE# '.�) 6-10 BLDG PERMI #
GN TU /POSITION DATE
TD-420. 29 ANUF HOME APPL(R/2W)OR(W)Page 1 of2