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• <br /> PtAieSEF' 908 . Saeie\ <br /> .. ..`.: f .. .. NATURE OF FILING.(check all that applies).: <br /> >e s ict�t serest ❑■ Change ownership I o n • ' to Oat • d•••• iti <br /> {;: s5seal-property : -ma ri - n r•, •.••.: • tatus F.! Trip permiton ert o sto e <br /> 0 Other: NEW HOME <br /> n f ' <br /> APPLICANT INFORMATION <br /> ❑ Dealer/seller ❑ Lender ■❑ 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 /> HOME INFORMATION;(*required) <br /> I tome ID number(if known): DMV X-plate number(if known): <br /> NEW <br /> to Oaf <br /> ❑ Moving in from another state <br /> Has no home ID or X-plate because: ❑ Coming out of county deed records <br /> ❑ Other: NEW HOME <br /> Manufacturer: MARLETTE Model: 55MJC28523CH21 Year:2021 <br /> Manufacturer serial number HUD number <br /> HER0327650RA NTA 2016134 <br /> HER0327650RB NTA 2016135 <br /> *Number of sections: 2 *Square footage:1386 *Number of bedrooms:2 *Number of bathrooms:2 <br /> *Type of roofing: COMP *Type of siding: LAP HARDWD *Heating: ELECTRIC *Cooling: <br /> *Date of sale: 4-30-2021 *Sales price: $00.00 *Includes land: ❑ Yes I]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(print): Dealer signature: Date: <br /> TRANSPORTER INFORMATION (If not moving, I`eave blank) <br /> Transporter name: Transporter address and phone: <br /> 440-2952(7/19/COM) Page 2 <br />