Laserfiche WebLink
�- c.ho C� s &u, te� o <br /> o a Z3 <br /> NATURE OF FILING(check all that applies) <br /> ❑Change secuntyinterest } Change ownership 0 Demolition Date of demolition: <br /> ❑Recording as real property 0 Removing from real property status ❑Trip permit �❑Converted to storage <br /> ❑Other. <br /> APPLICANT INFORMATION <br /> ❑Dealer/seller I 0 Lender 0 Escrow/trtle'agent Trig Owner/buyer- 0 Legal representative <br /> Name: (d \\-toss a S '(vli'-i tt Z C: <br /> Address(including city,state,and ZIP): ,1 <br /> Phone. SI d' 371; '..ti22,1.. ..... <br /> Ismail: K 'iS: !:✓)v 4dUek. `tai(:Co 14-1 ...._.r <br /> HOME INFORMATION(°roeluirod) <br /> Home ID number(If known): DMV X-plate number(If known): <br /> a7044o, <br /> ❑Moving in from another state ^» <br /> p ❑Coming out of county deed records <br /> Has no,home ID or X-late because:� _ <br /> ❑Other: _ <br /> Manufacturer: SK`e(,TN a Model: U►.kivarn Year: 17?Z_ <br /> Manufacturer serial number HUD number <br /> 34.110Ep <br /> 31{R ED?23 E 8 <br /> *Number of sections: Z Square footage:I a32.• *Number of bedrooms: 3 „'Number of bathrooms: Z <br /> *Type of roofing: [p/wrQ *Type of siding:`T' (- l 4 Heating: L(�fYa *Cooling: bona.. <br /> Date of sale: (), •"a o al °Sales price 30, . *Includes land:❑Yes is No <br /> DEALER INFORMATION(If no dealer,leave blank) <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 bsubject.to penalty for perjury. - - <br /> Dealer name"(prfsrt): Dealer signature: Date: <br /> TRANSPORTER INFORMATION(if not moving,leave blank) <br /> Transporter name: Transporter address and phone: <br /> 440-2932(7/19/COM) Page 2 <br />