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• vv J <br /> • <br /> lE (06 1\10,(-1-h con-k ct_v,r\ ijkADa- I <br /> NATURE OF FILING (check all that applies) <br /> v ' _ :e v rest El Change ownershipembtrt V!ware di%QeI12e <br /> aR! s gorfA,gpertg er 6v g i m e pro �'❑- rip pct' onv i to to s rage <br /> ❑gher: <br /> APPLICANT INFORMATION <br /> ❑■ 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): DMV X-plate number(if!clown): <br /> I i. / <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:SKYLINE/CHAMPION HOME BUILDERS Model:G560 Year:2021 <br /> Manufacturer serial number HUD number <br /> 245-000-H-Al 00744A <br /> 245-000-H-Al 00744B <br /> *Number of sections:2 *Square footage:1386 *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: '412712-.1 *Sales price:$96,814.04 *Includes land: ❑Yes 0 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 /> 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 'ion.i�ed#A and belief,and that I understand it is <br /> made for use as evidence in court and is subject to penalty fox"- i-jur <br /> Dealer name(print): Deals' �{tlrir�: Date: <br /> CASCADE FACTORY HOMES INC 7 /J -y l �2 <br /> 1 �r � I <br /> TRANSPORTER INFORMA I` N of 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 /> 440-2952(7/19/COM) Page 2 <br />