Laserfiche WebLink
I-act) H‘t 1 ) cc,) <br /> NATURE 6F.FILING (check all that applies)., <br /> Dekoke-sieerrityAteRst Change ownership \,s i io ' ' n jI t `ale"m�l't <br /> ee d rig p rt .2�� tm'gfrom\Leal-pcopert us +.4 Trip permit IIIei�tq ra, e <br /> Qkcether: <br /> • APPLICANT INFORMATION <br /> ❑ Dealer/seller ❑ Lender ❑ Escrow/title agent 11 Owner/buyer ❑ Legal representative <br /> Name:Mark J Schweitzer <br /> Address (including city, state,and ZIP):126 Gates Hill Road, Gates, OR 97346 <br /> Phone: 503-400-1798 <br /> Email:schweitzermarkj1@gmail.com <br /> NOME INFORMATION'(*required) <br /> Home ID number(if known): DMV X-plate number(if known): <br /> 245504 (3 ‘,�5 <br /> n Moving in from another state <br /> Has no home ID or X-plate because: Coming out of county deed records <br /> n <br /> Other: <br /> Manufacturer:Golden West Model:Espirt Year:1985 <br /> Manufacturer serial number HUD number <br /> GW3OREES05884A ORE 138561 <br /> GW3OREES05884B ORE 138562 <br /> *Number of sections: 2 *Square footage: 1296 *Number of bedrooms: 3 *Number of bathrooms: 2 <br /> *Type of roofing:Comp *Type of siding:T1-11 *Heating:Electric *Cooling: none <br /> *Date of sale: 4-19-2021 *Sales price: $18,000.00 *Includes land: ❑ Yes 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, securityinterests, 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 (if not moving, leave blank) <br /> Transporter name: Transporter address and phone: <br /> b TADC)5m.nc; 5,11- 511 Wig <br /> 440-2952(7/19/COM) 3 Page 2 <br />