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95n ' Rivev -Hd ML973 <br /> NATURE OF FILING (check all that applies) <br /> JICNe s .. ity\n e t Xhange ownership [ e oliti ' 1. e e `,.v it .•. 7 <br /> e or 'ng se pe $ee ming mkgp a s ri ear i rto tefale <br /> �� ''i - . . APPLICANT INFORMATION • •.':l. . <br /> ❑Dealer/seller 11Lender /) ❑,,Escrow/title agent gOwner/buyer El Legal representative <br /> �"' rid <br /> Name: �' T I ' " A. L tA-K�f'�Y 1 wO <br /> Address (including city,state,and ZIP): cis--1 ekvuK go 9-7303 <br /> Phone: ")5 1 ci9 0663 . <br /> Email: e o is U fir^OiWI L O ,0/ <br /> 111-(1.2j. <br /> . :d1" :`..1fyN fen.-'.. 1 _ <br /> ' -,.. `y:,,:,,, :•.::;:.: ,. .:.. ,HO.1 E I• ORMATION t.,,re euired _'.:: ::z;,,. . r_._:. . �K:1:}r= �..v.:.,. .... <br /> Home ID numb r(if known): DMV:X-plate number(if known): <br /> n Moving in from another state <br /> • <br /> Has no home ID or X-plate because: - ❑ Coming out of county deed records <br /> n Other: <br /> - Manufacturer: r 1 (4--m2.406 A Model: 1' F14S(2,bl Year: az <br /> Manufacturer serial number HUD number <br /> Pl-�20 CDA D L -22�0 <br /> 0,--6______: 7-9 7 <br /> .1 1 • IS <br /> P1-1— ZW SL O C, O Li-z32c) <br /> *Number of sections:• ,5 *Square footage:l lI 1 *Number of bedrooms: £4.- *Number of bathrooms: <br /> *Type of roofing: (1 Wr *Type of siding: ovin/i • *Hearing: etT*Cooling: IV <br /> AW <br /> *Date of sale:01,,h(//2401, *Sales price: 2 *Includes land: ❑ Yes grNo <br /> ..... .. .. ... ... ...M..:<.MAa. IO,-.,,is. .r n ec,�'..•,,-s;;:w D�s ".:.:,- <br /> ._ <br /> . DEALER INFORTi (ifno dealer ;leaveblank)= <br /> .. <br /> Dealer name: Dealer license number: Dealer address and phone: <br /> N This manufactured struci re is free and clear of all mortgages, deeds of trust,sec •ty interests, and liens.I have the <br /> l::al right to sell this man actured structure. <br /> I heredeclare that the abov statement is true to the best of my knowledge and be 'ef, and that I understand it is <br /> made fo use as evidence in cour and is subject to penalty for perjury. <br /> Dealer nam: print): f Dealer signature: Date: <br /> tio <br /> i:.11.. . TRANSPORTER IN RMATION (if not moving, leave blank) <br /> • <br /> Transporter name: ransporter address and phone: <br /> 440-2952(7/17/COM) Page 2 <br />