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• <br /> 5 ab ColUr - Cfe-e RC) IN Ve- 4-0 n <br /> NATURE OF FILING (check all that applies) <br /> 11S19we..z.jy-vreairi * Change ownership &.15husalifiN....451-io <br /> f!. Nn_ .s 1p ;e no •_ n ..0 t.. s Trip permit v t to ge <br /> APPLICANT INFORMATION <br /> * Dealer/seller Lender El Escrow/title agent Owner/buyer Legal representative <br /> Name:LEISURELAND HOMES INC <br /> Address (including city, state,and ZIP):33964 OAKVILLE RD SW ALBANY OR <br /> Phone:541-928-1555 <br /> Email:MINDY21M@COMCAST.NET <br /> HOME INFORMATION (*required) <br /> Home ID number(if k-noltn): DMV X-plate number(if known): <br /> NEW HOME <br /> '0 Moving in from another state <br /> Has no home ID or.X-plate because: Coming out of county deed records <br /> • Other: NEW HOME <br /> Manufacturer:FLEETWOOD WAVERLY OREST Model:28703C Year:2021 <br /> Manufactureserial number HUD number <br /> FLE210OR20-21189 A & B ORE554280 <br /> ORE554281 <br /> *Number of sections:2 *Square footage:1866 *Number of bedrooms:4 *Number of bathrooms:2 <br /> *Type of roofing: ARCH *Type of siding: CEMENT *Heating:ELECTRIC *Cooling:NONE <br /> *Date of sale:10/09/2020 *Sales price:102,949.00 *Includes land: 0 Yes 0 No <br /> DEALER INFORMATION (if no dealer, leave blank) <br /> Dealer name: Dealer license number: Dealer address and phone: <br /> LEISURELAND HOMESINC MSD119 33964 OAKVILLE RD SW ALBANY OR <br /> 541-928-1555 <br /> OThis manufactured structure is free and clear of all mortgages, deeds of trust,security interests, and liens. I have the <br /> legal right to sell this Manufactured structure. <br /> I hereby declare that the above statement is true to the best of my . wledge and belief, and that I understand it is <br /> made for use as evidence in court and is subject to penalty for p -j <br /> Dealer name (print): Dealer si4 . ure: Date: <br /> LEISURELAND HOMES <br /> TRANSPORTER INFORMATIv N (if not moving, leave blank) <br /> Transporter name: Transporter address and phone: <br /> SAME AS ABOVE SAME AS ABOVE <br /> 440-2952(7/19/COM) Page 2 <br />