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NATURE OF FILING (check all that applies) <br /> V2' geas it 't eef e t El Change ownership -0 1-.:. . a'- •f._ o `• . <br /> ty . 'ng, m --. p •.- . s ❑■ Trip permit Ealconvptutegtprvi <br /> APPLICANT INFORMATION <br /> ❑Dealer/seller ❑Lender ❑Escrow/title agent ❑l Owner/buyer ❑ Legal representative <br /> Name:Bridges RV Storage Inc. <br /> Address(including city,state,and ZIP):876 Taybin rd NW Salem,OR. 97304 <br /> Phone:503-363-3920 <br /> Email:bridgesstorage@gmail.com <br /> HOME INFORMATION (*required) <br /> Home ID number(f known): DMV X-plate number(.f known): <br /> 283932 X237506 (lrl 13-540 <br /> �— <br /> ❑Moving in from another state <br /> Has no home ID or X-plate because: ❑Coming out of county deed records <br /> ❑Other: <br /> Manufacturer:Guerdon Model:S48200 Year:1996 <br /> Manufacturer serial number HUD number <br /> GDSTOR149618154 <br /> *Number of sections:2 *Square footage:1286 *Number of bedrooms:3 *Number of bathrooms:2 <br /> *Type of roofing:asphalt shinglE *Type of siding:lap siding *Heating:heat pump *Cooling:yes <br /> *Date of sale:06-09-2020 *Sales price: $1.00 *Includes land: ❑Yes El No <br /> DEALER INFORMATION (if no dealer, leave blank) <br /> Dealer name: Dealer license number: Dealer address and phone: <br /> ❑This 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 knowledge and belief,and that I understand it is <br /> made for use as evidence in court and is subject to penalty for perjury. <br /> Dealer name(prim): Dealer siunature: Date: <br /> TRANSPORTER INFORMATION (if not moving, leave blank) <br /> Transporter name: Transporter address and phone: <br /> 0) 21 2i L1NSI6 t9itO or r-- <br /> }4AZ(.4‘ 0I. 973 <br /> 440-2952(7/19/COM) Page 2 <br />