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• <br /> q q cu\-eA- E , ALLY() 11-9 <br /> NATURE OF FILING (check all that applies) <br /> e t+ekrc c t 0 Change ownership [IVNyrti►1 ): e . d=n. iti •. <br /> er s ah�i ■❑Trip permit E/t ret t t ge <br /> • <br /> APPLICANT INFORMATION <br /> 0 Dealer/seller ❑ Lender ❑Escrow/title agent ❑ Owner/buyer ❑ Legal representative <br /> Name: LEISURELAND HOMES INC <br /> Address(including city,state,and ZTP): 33964 OAKVILLE RD SW ALBANY OREGON 97302 <br /> Phone: 541-928-1555 <br /> Email: MINDY21M@COMCAST.NET <br /> HOME INFORMATION ('required) • <br /> Home ID number(if known): DMV X-plate number(if known): ,, •//�� <br /> NEW ( 0360I V <br /> ❑ Moving in from another state • <br /> Has no home lD or X-plate because: ❑ Corning out of county deed records <br /> 0 Other:NEW <br /> Manufacturer:Fleetwood Weston Model:24482V Year:2022 <br /> Manufacturer serial number HUD number <br /> FLE2100R21-21799 A&b ORE 556675 <br /> ORE 556676 <br /> *Number of sections:2 *Square footage:1119 *Number of bedrooins:2 *Number of bathrooms:2 <br /> *Type of roofing: ARCH *Type of siding: CEMENT *I-Ieating: ELECTRIC *Cooling: NONE <br /> *Date of sale:07132021 *Sales price:87572 *Includes land: ❑ Yes ■❑No, <br /> • <br /> DEALER INFORMATION (if no dealer, leave blank) • <br /> Dealer name: Dealer license number: Dealer address and phone: • <br /> LEISURELAND HOMES INC MSD 119 33964 OAKVILLE RD SW ALBANY <br /> OREGON 97302 <br /> 541-928-1555 <br /> El 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 kngwledge and belief, and that 1 understand it is <br /> made for use as evidence in court and is subject to penalty, for perjyy. <br /> Dealer name (print): Dealer signature: Date: <br /> LEISURELAND HOMES INC � 1� 771 <br /> • <br /> TRANSPORTER INFORMATION (if not moving, leave blank) • <br /> Transporter name: Transpqter address and phone: <br /> LEISURELAND HOMES INC 33964 OAKVILLE RD SW ALBANY OREGON 97302 <br /> 541-928-1555 <br /> 440-2952(7/19/COM). Page 2 <br />