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DocuSIgn Envelope ID:74F2A1DE-9D59-4109-9C5A-D84C7C2401D0 <br /> L-r) N •1461696NATURE OF FILING(check all that applies) <br /> U__91aThsolifit?iatstruirri Change ownershipno tti bite f d <br /> n 'si,_ :,: , r a, . n, 'i,: :.n ,u..;" status n TIip permit n'Cpr1ya� gC+ <br /> EtOth'k_ <br /> A.APPLICANT INFORMATION <br /> Dealer/seller [,Lender []Escrow/title agent 0 Owner/buyer 0 Legal representative <br /> Name:James Austin and Lisa Austin <br /> Address(including city,state,and al):11633 WARBLER LANE AURORA OR 97002 <br /> Phone: <br /> Email: <br /> HOME INFORMATION required) <br /> Home ID number(fknown): N &-v / DMV X plate number(if mown):, 0 ,p G ( A <br /> Ej Moving in from another state C544 8� tel` <br /> Has no home ID or X plate because: 0 Coming out of county deed records <br /> 0 Other: <br /> Manufacturer:CMH HOMES INC Model:BREEZETARMHOUSE Year:2022 <br /> Manufacturer serial number HUD number <br /> ALB041283ORAB <br /> *Number of sections: 2- *Square footage: *Number of bedrooms: 3 *Number of bathrooms: Z. <br /> *Type of roofing. *Type of siding: *Heating: 6 *Cooling: <br /> *Date of sale:-2)g.,412, *Sales price: *Includes land: <br /> � ���� oyes�o <br /> DEALER INFORMATION(if no dealer,leave blank) <br /> Dealer name: Dealer license number. Dealer address and phone: <br /> CLAYTON HOMES ALBANY,OR DLR M S D 19 5 1437 CENTURY DRIVE NE <br /> CCB #166990 ALBANY OR 97322 <br /> (541)9674555 <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 belieZ 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): Dealer signature: Date: <br /> ern 14am RMA ry 1-0.�cj <br /> SPORTER INFON(If not moving,leave blank) <br /> Transporter name: Transporterasldres a and phone: Q 1 g 4 34 5501 <br /> 13 I -z, NCI I ? 6.�1 'order. ter. <br /> s, aa. of <br /> 440-2952(7119/COM) <br /> OR Title Application-10/2019-TItlMAppI1211 Page 2 004564249-00001 <br />