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` NATURE:OF.FILING (check all that applies) <br /> [ ac c e kLijtt�0 Change ownershipem itiaC\Ba e"t kder olio <br /> cordi las alp m in om l rot, tatais S i s •e .. III .i ve •• to storage <br /> [30"__r: <br /> • . , . APPLICANT.INFORMATION - <br /> ❑Dealer/seler I ❑Lender I ❑ Escrow/title agent ❑ Owner/buyer I ❑Legal representative <br /> Name:Marilou Salazar <br /> Address(including city, state, andZIP):185 47th Ave. Salem, Oregon 97301 <br /> Phone:503-999-7569 <br /> Email: <br /> HOME INFORMATION (*required). . <br /> Home ID number(if known): DMV X-plate number(if known): <br /> New 553218 3 Cp b3-7 ,j <br /> E.Moving in from another state <br /> Has no home ID or X-plate because: [ Coming out of county deed records <br /> 7 Other: <br /> Manufacturert Fleetwood Model:Weston I Year:2021 <br /> Manufacturer serial number HUD number <br /> FLE2100R20-20894A <br /> `Number.ofections:1 I *Square footage:840 *Number ofbedrooms:2 1 *Number ofbathrooms:2 <br /> *Type ofroofing:comp I *Type of siding:Wood l *Heating:Efectric *Cooling:Heat Pump <br /> *Date of salei07/19/2021 *Sales price:75900 1 *Includes land: DIYes El No <br /> 0 DEALER INFORMATION (if no dealer, leave blank) - <br /> Dealer name: Dealer license number: Dealer address and phone: <br /> asstsi#:::EMI Brian L. Fitterer, Inc. 18006 Sky Park Circle Ste 200 <br /> David Bates A,uthorized signature for MSD410 Irvine Ca, 92614 <br /> [?6513cf-sq Brian L. Fitterer, Inc 949-440-2300 <br /> I ' <br /> This manufactured structure is free and clear of all mortgages, deeds of trust, security interests, and liens.I have the <br /> legal righ to sell this manufactured structure. <br /> I hereby dec are 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:efiL-pl. ,i2 ��� Date: <br /> • 8/18/2021 <br /> TRANSPORTER INFORMATION (if not moving,-leave'blank). - •- <br /> Transporter name: Transporter address and phone: <br /> Unknown <br /> 440-2952(7/19/COM) Page 2 <br />