Laserfiche WebLink
630 Nuf-\-\-) ScoirN-- 2) cuonGcci-es X 734 <br /> NATURE'OF FILING (check all that applies) <br /> e e n, to e\A❑a • temo ','•n Oat, of iti.n: <br /> ELR.E<NIdg\asifeNprpe / Nnov s: n e. ..e • us I Trip permit NrettAstdnoistorage <br /> :APPLICANTiNFORMATION <br /> ❑Dealer/seller ❑Lender ❑Escrow/title agent ❑ Owner/buyer ❑ Legal representative <br /> Name: CA6rN Cry( M 7 C !� } <br /> Address (including city,state,and ZIP): 'P.c . 0( 8(0355, Vo' -,Cf ne) 0R CI-1gPico <br /> Phone: 563 <br /> Email: <br /> HOME INFORMATION.(*required), <br /> Home.ID number(if known): DMV X-plate number(if known): <br /> 281087 f p6 <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: GOLDEN WEST Model: UNKNOWN Year:1994 <br /> Manufacturer serial number HUD number <br /> GW6CALGV10548AB <br /> GW6CALGV10548AB <br /> *Number of sections: 2 *Square footage: 1716 *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: 3—cen *Sales price: *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,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 /> • r TRANSPORTER INFORMATION(it not moving, leave blank) <br /> Transporter name: Transporter address and phone: <br /> 440-2952(7/19/COM) Page 2 <br />