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83C) Elk horn Dr. , L 0 5 9:-/,35� <br /> NATURE OF FILING (check all that applies) <br /> UNg s u ' n e s El Change ownership e t f e o 'ti <br /> E/JVQ di as •e plAgeca c....11aj v' eal n rt ra e <br /> APPLICANT INFORMATION <br /> Q Dealer/seller ❑Lender ❑Escrow/title agent ❑ Owner/buyer ❑ Legal representative <br /> Name: CASCADE FACTORY HOMES INC <br /> Address(including city,state,and ZIP): 590 N PACIFIC HWY,WOODBURN OR 97071 <br /> Phone: 503-981-5314 <br /> Email: CASCADE FACTORY HOMES <br /> HOME INFORMATION (*required) <br /> Home ID number(if known): �A / DMV X-plate number(if known): <br /> V 360a43 <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:FLEETWOOD HOMES Model:EG28483S <br /> Year:2021 <br /> Manufacturer serial number HUD number <br /> FLE2100R20-21028A ORE 553730 <br /> FLE2100R20-210286 <br /> ORE 553731 <br /> *Number of sections:2 *Square footage:1,279 *Number of bedrooms:3 *Number of bathrooms:2 <br /> *Type of roofing:ARCH SHING *Type of siding: CEMENT *Heating:ELECT *Cooling:N/A <br /> *Date of sale: 3id Q *Sales price:$72,427 *Includes land: ❑Yes %No <br /> DEALER INFORMATION (if no dealer, leave blank) <br /> Dealer name: Dealer license number: Dealer address and phone: <br /> CASCADE FACTORY HOMES INC MSD-41 590 N PACIFIC HWY <br /> WOODBURN OR 97071 <br /> 503-981-5314 <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 peer' ry. <br /> Dealer name(print): Dealer si a+ 'r, Date: <br /> CASCADE FACTORY HOMES INC ;, 3/15/20-1 <br /> TRANSPORTER INFORMATIO (if not moving, leave blank) <br /> Transporter name: Transporter address and phone: <br /> SUPERIOR HOME TRANSPORT LLC PO BOX 1067 JEFFERSON, OR 97352 <br /> 503-551-3454 • <br /> I 440-2952(7i 19/COM) Page 2 <br />