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, ,. . <br /> a Tb L <br /> DocuSign Envelope ID:CA80226A-662D-4385-1 -45146CC927135 <br /> 1424001 <br /> NATURE OF FILING(check all that appliea) • <br /> 0 Change security interest 'IS6 Change ownership ID Demolition Date of demolition: <br /> 0 Recording as real property I Ei Removing from real property status "ALrip permit-1 0 Converted to storage <br /> 0 Other: <br /> APPLICANT INFORMATION <br /> 0 Dealer/seller 10 Lender 1 0 Escrow/title agent I 0 Owner/buyer 1 0 Legal representative <br /> Name:Michelle Connor <br /> Address(including city,state,and ZIP):2S0 TUMBLE STREET DETROIT OR 97342 <br /> Phone: <br /> Email: <br /> HOME INFORMATIONI*required) <br /> Home II)number(if known): IDMNI X-plate number(if known): <br /> 0 RV) CA 0 0 0-1 q7.1 <br /> — — - <br /> 0 Moving in from another state <br /> 0 Coming out of county deed records — <br /> Has no home ID or X-plate because: <br /> 0 Other: <br /> Manufacturer:CLAYTON Model:REDWOOD 2 [Year:2021 <br /> Manufacturer serial number <br /> 1 HUD number <br /> ALB04063SORAB <br /> *Number of sections: ;)_... I*Square footage:10Z,41*Number of bedrooms: 2.._ *Number of bathrooms:2•-- <br /> *Type of roofing: (al r, 7 *Type of siding: ( r *Heating: I=A E Cooling: 0.4. <br /> *Date of sale: Li 1 (-...2, zr, .J *Sales price: 1 j*..} .000 7-- <br /> *Includes land: 0 Yes tgNo <br /> 1 DEALER INFORMATION(If no dealer,leave blank) <br /> 'Dealer name: i Dealer license number: Dealer address and phone: <br /> !CLAYTON HOMES ALBANY,OR <br /> k%, ic 1437 CENTURY DRIVE NE <br /> b V <br /> ALBANY OR 97322 <br /> (541)967455S <br /> flThis 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 ,f my knowledge and belief,and that I understand it <br /> Is made for use as evidence in court and is subject trfeaalty t r perjury. <br /> Dealer name(print): Dealer signetyc-L: i1._ ---, Dat : <br /> Cict., 4-0-3-, i-icret APAt-le ' ,..4.71" <br /> TRANSPORTER INFORMATION (If not moving,leave blank) <br /> Transporter.name._ _ _ Transporter address,and.phonc: <br /> -,---t. e•Lc,-- 01:cmx,_q-lrill--q...fior.1-- 1 i S;',- S --2-81) sr--ittgrc4Aac).0.0 CR-Cli.—7 V-A71- <br /> . 1-t i - .1` 17 -1/ /0 7,--. <br /> 440-2952(7/19/C0M) <br /> OR Me AppEcelion-10/2.019-TniaApp11211 Paso 2 <br /> 004417493-00001 <br /> 1 <br />