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1431266 <br /> NATURE OF FILING(check all that applies <br /> C = erest g s <br /> �1 ►;a 'ot sat- • •em. <br /> '\ ,,o , .I up: � , �1� rip permit - <br /> O er: = e _� .orage <br /> APPLICANT INFORMATION <br /> ❑Dealer/seller ❑Lender ❑Escrow/title agent ig Owner/buyerLe <br /> Name: Gary Bell and Esther Brown ❑ gal representative <br /> Address(including city,state,and ZIP): 195 SE 2ND AV IDANHA OR 97350 <br /> Phone: <br /> Email: <br /> HOME INFORMATION (*required) <br /> Home ID number(if known): DMV X-plate number(ifknown): <br /> ❑Moving in from another state <br /> Has no home ID or X plate because: ❑Coming out of county deed records <br /> ❑Other: <br /> Manufacturer:CLAYTON <br /> Model:DRM401M Year:2021 <br /> Manufacturer serial number <br /> BUD number <br /> ALB040780OR <br /> *Number of sections: / *Square footage:b Op *Number of bedrooms: <br /> *Number of bathrooms: <br /> *Type of roofing: METAL *Type of siding: <br /> eY, Heating: ��4� *Cooling: <br /> *Date of sale: sli!INI*Sales price: J I <br /> � 0-0-27 Includes land: ❑Yes IN No <br /> DEALER INFORMATION(if no dealer',leave blank) <br /> Dealer name: Dealer license number: <br /> Dealer address and phone: <br /> CLAYTON HOMES ALBANY, OR1437 CENTUR <br /> 01%6 I cl c ALBANY OR 97 DRIVE NE <br /> 22 <br /> (541)967-8555 <br /> Li 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 pear perjury. <br /> Dealer name(print): De. -r signa <br /> Date: <br /> Ott- A <br /> eS • ,._ ` zc,:JI <br /> TRANSPORTER INFORMATI <br /> Transporter name: (' not moving,leave blank)" <br /> Transporter address and phone: ,c7 <br /> 1Trusime. a — J-e trscok ©2 q- 35L SW-327-78 <br /> 440-2952(7/19/COM) <br /> OR Title Application-10/2019-TitleAppl 1211 <br /> Page 2 <br /> 004354784-00001 <br />