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/ AorrHes-1--e_a_6() Rc) <br /> 1417466 <br /> NATURE OF FILI 1G (che'ck aLI t�iatappifes) <br /> Change security interest Change ownership Demolition Date of demolition: <br /> ❑Recording as real property 0 Removing from real property status J Trip permit 0 Converted to storage <br /> 0 Other: <br /> APPLICANT INFORMATION,; <br /> Dealer/seller fl Lender []Escrow/title agent Owner/buyer 0 Legal representative <br /> Name:Gretchen Tregaskis and Ron Tregaslds <br /> Address(including city,state,and ZIP): 1700 HOMESTEAD RD.SALEM OR 97306 <br /> Phone: -a 7 -- y l - 7 Co-Ca <br /> Email: 1`.Q k-1 -} F' 4 5 k r 5 @ n10....t\ , <br /> H __ E INFORMATION.(*`required).... <br /> Home ID number(ifknown): DMV X-plate number(if known): <br /> E <br /> 0 Moving in from another state <br /> Has no home ID or X- late because: ❑Coming out of county deed records <br /> P <br /> 111 Other: <br /> Manufacturer:DRM521F 52 Model:72DRM28523A1121 Year:2021 <br /> Manufacturer serial number. HUD number ' ' <br /> ALB040458ORAB <br /> *Number of sections: *Square footage: 404. *Number of bedrooms: 3 *Number of bathrooms: <br /> *Type ofroofing:A,., Silin Iet,*Typeofsiding: Smur+. Peth e.( *Heating: 51.e4;11-;c_ *Cooling: Al/A <br /> *Date of sale: * price: 10.xis .61*Includes land: Q Yes No <br /> ,ZIZ S/21 Sales t <br /> DEALER INFORMATION(if nodealer,leave blank).._.._ <br /> Dealer name: Dealer ie nEym Dealer address and phone: <br /> CLAYTON HOMES ALBANY,OR <br /> CC- B #166990— 95 1437 CENTURY DRIVE NE <br /> ALBANY OR 97322 <br /> (541)967-8555 <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 <br /> is made for use as evidence in court and is subject to penalty for perjury. <br /> Dealer name(print): Dealer signature: DaT: <br /> � r r �e r ac94 i22 <br /> _NSP0RTER INFORMAT N(if.not moving,leave blank) ,. <br /> Transporter name: Transporter address and phone: "151 M. <br /> S�`fs�Trcar' —YIaw.L Tr-artsprie � f' �� 'BCJ L1's-arson OQ <br /> 440-2952(7/19/COM) <br /> OR Title Application-10/2019-TitleApp 11211 Page 2 004402474-00001 <br />