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5 Gu D o9,734 �-- <br /> 1415885 <br /> NATURE OF FILING (check all that applies) <br /> 0 Change security interest 0 Change ownership —Demolition Date of demolition: <br /> Recording as real property 0 Removing from real property status Eyt Trip permit ❑Converted to storage <br /> Other: <br /> APPLICANT INFORMATION <br /> Dealer/seller 0 Lender 0 Escrow/title agent 0 Owner/buyer 0 Legal representative <br /> Nam :Donnie Johnson and Brenda Johnson <br /> Address(including city,state,and ZIP): 195 GUY MOORE DRIVE DETROIT OR 97342 <br /> Phone: <br /> Email: <br /> HOME INFORMATION (* required) <br /> Home ID number(if known): r � DMV X-plate_number(if known): 0 <br /> Moving in from another state <br /> Has no home ID or X-plate because: ❑Coming out of county deed records <br /> 0 Other: <br /> Manufacturer:FLEETWOOD NAMPA B Model: TIMBERWOOD Year: 2021 <br /> Manufacturer serial number HUD number <br /> FLE230ID2034983AB <br /> *Number of sections: 2... *Square footage:2_ohlC71*Number of bedrooms: 3 *Number of bathrooms: 2_.. <br /> *Type of roofing: �' � *Type of siding: pc.�, a,S *Heating: CIS G-ir *Cooling: <br /> *Date of sale: (;),2- 11 -2_J *Sales price: 19 S 07,4 *Includes land: 0 Yes allo <br /> DEALER INFORMATION (if no dealer, leave blank) <br /> Dealer name: Dealer iic 111.1"j; ' D195 Dealer address and phone: <br /> CLAYTON HOMES ALBANY,OR <br /> CCB #166990 1437 CENTURY DRIVE NE <br /> ALBANY OR 97322 <br /> (541)967-8555 <br /> 0 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 <br /> is made for use as evidence in court and is subject to penalty for perjury. <br /> Dealer <br /> name(print): Dealer signature: Date: <br /> Drnt- Ar\f_tat/R wc l 4G . ti.kms'TRANSPOINFORMA I N (if not moving,ER o `� /z) <br /> leave blank) <br /> Transporter.name: _ Transporter.address and phone: 5141 <br /> t7? for Ctory-+e s RS- N lr, \.1 e. c-ers®n cl '13 5 D <br /> 440-2952(7/19/COM) <br /> OR Title Application-10/2019-TitleApp 11211 Pagc 2 004414866-00001 <br />