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I , <br /> • <br /> -4 <br /> ao(-) LCIn cas ? R 5 -A- ct,`eitn 9 -13 / <br /> NATURE OF FILING:(check all that pplies) ...: <br /> P. :e c t tern ■❑ Change ownership rti of em • • n <br /> 'e •rdie_ a-• re•- . pe � 'el,.' n r= •ro. • tat • 'r : .er i• • d t . • -.ge <br /> , <br /> APPLICANT'INFORMATION:.. <br /> ❑ Dealer/seller ❑ Lender 0 Escrow/title agent ❑ Owner/buyer ❑ Legal representative <br /> Name: NW HOMEBUYERS.NET (DANA HUNDLEY-OFFICE MANAGER) <br /> Address(including city, state, and ZIP): 7921 SE KING ROAD, STE 1, MILWAUKIE, OR 97222 <br /> Phone: 503-762-1915 <br /> Email: DANA NWHB@MSN.COM • <br /> OME INFORMATION (*required) <br /> Home ID number(if known): DMV X-plate number(if known): <br /> NEW Look \tEl <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: MARLETTE Model:55CRC24443BH21 Year:2021 <br /> Manufacturer serial number HUD number <br /> HER0327440RA NTA2011440 <br /> HER0327440RB NTA2011441 <br /> *Number of sections: 2 *Square footage:1056 *Number of bedrooms:3 *Number of bathrooms:2 <br /> *Type of roofing:COMP • *Type of siding:LAP HRDWD *Heating:ELECTRIC *Cooling:N/A <br /> *Date of sale: 4-30-2021 *Sales price: $00.00 *Includes land: ❑Yes 0 No <br /> • <br /> D6ALER INFORMATIOId'(lfano 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(print): Dealer signature: Date: <br /> TRANSPORTER INFORMATION (lf not moving,=leave blank) <br /> Transporter name: Transporter address and phone: <br /> 440-2952(7/19/COM) Page 2 <br />