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Aug 1 U 2'1,04:24p Dougs Mobile Home Service 503-200-1299 p.2 <br /> to -`�S H-ct2-e- (r rr-ey-) Rd & <br /> �:;�-..::,::.- . ,.... ..n1,�►t.uFc�.r�r.t-ii.Ivy=:�r.�.eaEc�a� .:ural. gyres. -- <br /> ❑Change security interest Change ownership ❑ Demolition Date of demolition: <br /> ❑Recording as real property Removing from real property status Trip permit ❑ Converted to storage <br /> Cl Other <br /> Dealer/seller ❑Lender f ❑Escrow/title agent ❑ Owner/buyer ❑ Legal representative <br /> Name: <br /> Address(including city, state,and ZIP): ,a_6 e� Jj c-,r- ?7 Z. <br /> Phone: S-6., 3-- 79 7 4:3,..5-36 <br /> Email: •6 <br /> ::..:::... <br /> -.Hfl E:I�ttEb MA-: ON _ <br /> Home ID number(if known): DMV X-plate number(if known): <br /> Co -D-- n ) <br /> ❑Moving in from another state <br /> Has no home ID or X-plate because: ' El Coming out of county deed records <br /> ❑Other: <br /> Manufacturer: 7u S< e Model: Year:c7cze, <br /> Manuf chid r` ri l :m :. <br /> VCl l OC)1?4(o-Yr 8 o R b-4},G�q <br /> c1; 4 6-1 <br /> *Number of sections: 1 *Square footage: *Number of bedrooms: '' *Number of bathrooms: <br /> *Type of roofing: 6vzvtp *Type of siding: !-Ty _LL *Heating:6� *Cooling: -Is)._ <br /> *Date of sale: e?--F–j_2,./ <br /> *Sales puce- *Includes land: Yes No <br /> :.... <br /> o�:d�'al c<: 'eav� <br /> n �-i 1a� <br /> -gib �k- <br /> Dealer name: Dealer license number: Dealer address and phone: <br /> DOUG WALTON MSD 462 <br /> DOUG'S MOBILE HOME SERVICE <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 signa - Date: <br /> pc)c. f.> <br /> T�4Id TER:-aNF- R �.d. <br /> NIATI. a mo�i_n" _ie <br /> N:� ..:�nv. .axe: <br /> T spotter name: - Transporter address andOne: <br /> ne: <br />