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g.a5 ; <br /> 1439195 <br /> NATURE OF FILING(check all that applies) <br /> y •• gse F'ty i er- t •,:e e on t e of i <br /> J o • re• pr. e •em. ; g fro 1:4•Qupple14.AQV Trip permitnv ifeeyyttorage <br /> (10, er. <br /> APPLICANT INFORMATION. <br /> ❑Dealer/seller ❑Lender 0 Escrow/title agent n. Owner/buyer 0 Legal representative <br /> Name:Robert Bruce and Tammy Alberts <br /> Address(including city,state,and ZIP):225 HILL ST.DETROIT OR 97342 ✓ <br /> Phone: 5o ' AGO .... Ea:)..S <br /> Email: bre cmc• bob 7Q. tt'14.; I : cow, <br /> `HOME INFORMATION_(*required) <br /> Home ID number(if known): A 1 E V DMV X-plate number(if known): <br /> �V 0 Moving in from another state (p <br /> Has no home ID or X-plate because: ❑Coming out of county deed records <br /> 0 Other: <br /> Manufacturer:PREFERRED PLUS CP561 Model: 72CPP28563CH21 Year:2021 <br /> Manufacturer serial number HUD number <br /> ALB040666ORAB <br /> *Number of sections: *Square footage: 15 M*Number of bedrooms: '' *Number of bathrooms: <br /> *Type of roofing:Arch ,S14;ziaype of siding:(cm P1 e k *Heating: 51exj-r i 4, *cooling: /i//4 <br /> *Date of sale: 8472 ( *Sales price: #110 g q *Includes land: Ig Yes No <br /> DEALER INFORMA1ON (if no dealer, leave blank) <br /> Dealer name: Dealer license number: Dealer address and phone: <br /> CLAYTON HOMES ALBANY,OR bit-e 44.Al ig I 'S 1437 CENTURY DRIVE NE <br /> G G 5 it 164 g q o ALBANY OR 97322 <br /> (541)967-8555 <br /> 0 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 penalty for perjury. <br /> Dealer name(print): DealerCsi ature• Date- <br /> 1bC. c <br /> CIGiY i'G n �{orp� o WeAt <br /> TRANSPORTER INFORMATION (if n tmoving, leave"blank <br /> Transporter name: N. Transporter address and phone: .2357 N. .6. <br /> Sl,�fa�rinP TiOMt, .1 raoSport Sc4 -xx1 ?wg C1i3.sa. <br /> 440-2952(7/19/COM) <br /> OR Title Application-1012019-TitleApp11211 Page 2 004426479-00002 <br />