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To 0ecttev'5 Lai . 41351 i-.�.rne v SE <br /> DocuSlgn Envelope ID:FD02A388-17EA-4B60-9C59-B3F3FFB2336F <br /> O\z?A -corn CA-‘j. be_cukv‘5 <br /> ..ti. <br /> "c•• .:{ lie <br /> •RE F.�F N k. li' <br /> `0,8a.afftetnity4Ittrxest 0 Change ownership \ r -• •• ea • c •e r•olitr•n: <br /> �m� or' re r exy J11( . '.•.. '• • • ,p4 .tus ❑Trip permit C -4ge to ge <br /> :•....:.....::..•.......... .:.... .. ....,..:........ : .,LIC NTINF:O A ON:::::::•..:: :::::;':::'..::::.:...:::'::.: '.:`::•�.:::.::::,:::;,:::::,•.::,: <br /> 0 Dealer/seller ❑Lender ❑Escrow/title agent 0 Owner/buyer ❑Legal representative <br /> Name:Factory Homes Clearance Center Inc <br /> Address(including city,state,and ZIP):P 0 Box 2176 Tualatin OR 97062 <br /> Phone:971-224-2244 <br /> Email:janetm@gunnerlic,com <br /> - •re utred <br /> M'.TiU <br /> E�INF R A <br /> q s; <br /> Home ID number(if/mown): DMV X-plate number(if known): <br /> qbq <br /> ❑Moving in from another state <br /> Has no home ID or X-plate because: ❑Coming out of county deed records <br /> ❑ <br /> Other: <br /> Manufacturer:Fuqua Model:Fuqua Year:1994 <br /> Manufacturer serial number HUD number <br /> 13 2-32, ORE 362850 <br /> 13232- ORE 362851 • <br /> *Number of sections:2 *Square footage:1300 *Number of bedrooms:3 *Number of bathrooms:2 <br /> *Type ofroofrng:Comp *Type ofsiding:T11 *Heating:Electric *Cooling:None <br /> *Date of sale: *Sales price:15,000.00 *Includes land:❑Yes 0 No. <br /> ,.., : e e <br /> ....... ... ....:::::.. <br /> • <br /> MATZO if'no•dealer .l ay. .bfan{c �.':':: �•`•�.:�; ;`:;�:�: �::��=;�:�:' �::���•��:�': <br /> Dealer name: Dealer license number: ' Dealer address and phone: <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 signature: Date: <br /> �••: : :; <br /> .:O TE 1 FO TIO if•�not:movin tleays�.hlank <br /> 'TRANSP. R R . .. RIMA . N: , <br /> ,:..:.:... :...... .,. .. 1. ...:• .::.... .:.•;..,:1;,.�..•:•,.>l:•:.:.�.�?;: <br /> Transporter name: Transporter address and phone: <br /> Doug's MH Setup&Service 12692 Fry Rd NE <br /> Aurora, OR 97002 • <br /> 503-799-0539 <br /> 440-2952(7/19/COM) Page 2 <br />