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HomeMy WebLinkAboutBLD2007-00451 FROM :Jefferson County Assessor. FAX NO. :360-385-9197 "pug. 13 2007 02:57PM P2 I C)N C'pGJefferson County Assessor's Office THE HEART OF THEtocc OLYMPIC PENINSULA P.O. Box 1220, Port Townsend, WA 98368 I1 NG - Jack Westerman III, Assessor August I3, 2007 RE: Parcel #98 1002 2 13 To Whom It May Concern: Our records indicate that we began assessing a 1 974 mobile home on the above parcel in 1974 for taxes payable in 1975. In order for us to assess this mobile It would have had to sit on the property prior to July 3 I " of that year. If you should need any additional information please contact our office at (360)385-9 105. Jami Trafton Jefferson County Assessor's Office (360) 385-9105 . FAX(360) 385-9197 . web site: www.co.jefferson.wa.us , • S ------E)D 0_00 IA45\i, RETURN ADDRESS Frank Van Der Harst Jessica Van Der Harst `► \ 952 164 Ave SE \-\ ' —.-1: 42:: \ 41.‘ 6Thr-- Bellevue,WA 98008 L47D O TSHINGTON MANUFACTURED HOME IICEnsinc APPLICATION D TITLE ELIMINATION 0 TRANSFER IN LOCATION ❑REMOVAL FROM REAL PROPERTY Anyone who knowingly makes a false statement of a material fact is guilty of a felony,and upon conviction may be punished by a fine,imprisonment,or both. (RCW 46.12.210) D MANUFACTURED HOME TPO/PLATE NUMBER YEAR MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN) W47548 1963 Clarion _ 55/10 S2208 © LAND LEGAL DESCRIPTION ON PAGE 2 REAL PROPERTY TAX PARCEL NUMBER MANUFACTURED HOME WILL BE ®AFFIXED 0 REMOVED 981002213 LOT BLOCK PLAT NAME OR SECTION/TOWNSHIP/RANGE QUARTER/QUARTER SECTION 15 22 Olympic Canal Tracts © GRANTOR(S)REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE COUNTY NUMBER NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS 2 2 NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER Frank Van Der Harst NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER Jessica Van Der Harst ADDRESS CITY STATE ZIP CODE 952 1640,Ave SE Bellevue WA 98008 NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER SAME AS REGISTERED OWNERS ABOVE NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE GRANTEE NAME Frank Van Der Harst and Jessica Van Der Harst 1 DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT I/WE AM/ARE THE REGISTERED OWNERS)OF THIS VEHICLE AND THIS INFORMATION IS ACCURATE: Signature of Registered Owner and Title,IF APPLICABLE Signature of Additional Registered Owner and Title,IF APPLICABLE NOTARY SEAL OR STAMP NOTARIZATION/CERTIFICATION FOR REGISTERED OWNERS)SIGNATURE State of Washington Signed or attested County of before me on by Frank Van Der Harst Signature PRINTED NAME OF REGISTERED OWNER NOTARY OR AGENT Jessica Van Der Harst by PRINTED NAME OF REGISTERED OWNER PRINTED NAME OF NOTARY County/Office No.OR Title AND: Dealer No.OR DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Date D 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. III BUILDING PERMIT OFFICE CERTIFICATION I certify that: ® the manufactured home has been affixed to the real property as described. ❑ a building permit has been issued for this purpose and the attachment will be inspected upon completion. N E(TYPED OR PRINTED), BL G PERMIT OFFICE/PHONE# BLDG PERMIT# _A- hie (1Onk )kk;, 4 36-z: �.-31 -44�lc G`"1 C" '4 51 RE,(POSL O . e -- AT MANUF H ME APPL(R/2/02)EXT(W)Page 1 of 2 CO StreamLine Mobile-Manufactured Home Application Rev.8/8/2007 • • MANUFACTURED HOME—FROM SECTION 1 TPO/PLATE NUMBER YEAR MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN) W47548 1963 cLARION 55/10 S2208 II 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 REGISTERED OWNER(S)SIGNATURE State of Washington Signed or attested County of before me on by Frank Van Der Harst Signature PRINTED NAME OF LEGAL OWNER NOTARY OR AGENT by Jessica Van Der Harst PRINTED NAME OF LEGAL OWNER PRINTED NAME OF NOTARY County/Office No.OR Title AND: Dealer No.OR DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Date DLAND DESCRIPTION(A legal description of the land can be obtained from the local County Assessor's Office.) Lot 15,Block 22,Olympic Canal Addition 4,as per plat recorded In Volume 4 of Plats,pages 30-40,records of Jefferson County, Washington. © DEALER'S REPORT OF SALE I CERTIFY THAT THIS INFORMATION IS CORRECT,THE VEHICLES 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 DEALER'S AUTHORIZED SIGNATURE 0 USE TAX EXEMPT Sale to a Certified Tribal member on the reservation(attach notarized statement of delivery). Ell 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 ® TITLE FEES FILING FEE APPLICATION MOBILE HOME FEE ELIMINATION FEE USE TAX SUBAGENT FEES TOTAL FEES&TAX IMPORTANT: Once the application has been approved by the County AuditorNehicle 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 Home 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 call(360)902-3600 or TTY(360)664-8885. TD-420-729 MANUF HOME APPL(R/2/02)EXT(W)Page 2 of 2 SUS StreamLine Mobile-Manufactured Home Application Rev.8/8/2007