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• <br /> • ..:••NATURE OF.FILING, check.all that a p • liie.s. <br /> i,Cta es'ecatri i-ifite>ek Change ownership I [ f7en�oi{tioh�-IS�e of'de"�n clition. ''t.-r� ''`--t <br /> R'b lifgiauaal'property . O dviMgfiAhivel,prop rtystatus ❑Trip permit [ _Conuetteil`tgstop ge <br /> ❑Other: <br /> .: :APPLICANT INFORMATION <br /> Dealer/seller ❑Lender ❑Escrow/title agent ❑ Owner/buyer ❑ Legal representative <br /> Name:Factory Homes Clearance Center, Inc <br /> Address(including city,state,and ZIP):18150 SW Boones Ferry Rd Portland, OR 97224 <br /> Phone:971.224-2244 <br /> Email:Janelm@gunnerllc.com <br /> HOME INFORMATION (*required) . <br /> Home ID number(if/mown): DMV X-plate number(if/mown): <br /> 183088 (4 0 04 J • <br /> • <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:Freed Model: Year:1974 <br /> Manufacturer serial number HUD number <br /> 52242CK0891908H <br /> 52242CK0891908J <br /> *Number of sections;2 *Square footage:1300 *Number of bedrooms;2 *Number of bathrooms:2 <br /> *Type of roofing:Metal *Type of siding:Metal *Heating:Erlec *Cooling:Heat Pump <br /> *Date of sale:08/19/2021 *Sales price:20000.00 . *Includes land; ❑Yes (i No <br /> DEALER INFORMATION (If no dealer, leave.blank) • . <br /> Dealer name: Dealer license nmber: Dealer address and phone: <br /> FActory Homes Clearance Center Inc MSD215 18150 SW Scones Ferry Rd <br /> Portland,OR 97224 <br /> 971-224-2244 <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 ienalty for perjury. <br /> Dealer name(print): I-aler signature; Date; <br /> Fuc. . C[e.44„a.y1.4 Gad I,'(, . .. ... <br /> TRANSPORTER INFORM ION (If not moving, leave blank) •• <br /> Transporter name; ransporter address and phone: <br /> Doug's MH Setup and Transport 12692 Frey Rd NE <br /> Aurora, OR 97002 <br /> 440-2952(7/19/COM) Page 2 <br />