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' -9, -ffi'91 i:E'� H T i ..._ h k• '. "'F i id -zk - :-'�),'S - <br /> SOr\OV) etakC5 CAL CC7-5L1(40 <br /> a " _�� ,aP.+-. ya r a x j , n 3 � 4 N ` , .'" <br /> r''. . . � z MATURE OF FILING(cheek ail that applies) , <br /> ❑ Change security interest ■❑Change ownership ❑ Demolition Date of demolition: <br /> ❑ Recording as real property ❑■ Removing from real property status •Trip permit ❑ Converted to storage <br /> )they: <br /> � � APPLICANT INFORMATION __� f x _ : <br /> ❑Dealer/seller ❑Lender 0 Escrow/title agent ❑ Owner/buyer ❑ Legal representative <br /> Name:Western Title&Escrow <br /> Address (including city,state,and ZIP):497 Oakway Road Ste 340, Eugene, Oregon 97401 <br /> Phone:541+-485-3588 <br /> Email:tonya.silke@westerntitle.com <br /> "a 4 ms`s: r r�„ k - v`8- VPA;s'i --�'HOM� {a F 1.. = r iii ) .� a. `� --" c�a�r ' y.--t- ,45,.._, ,;E <br /> -�. �' "`� EINFORMA-`flOhT;(*re aired -�� °� ���-� � <br /> Home ID number(if known): DMV X-plate number(if known): <br /> � J <br /> i Z unknown 1IOn D-C-i/ <br /> ['Moving in from another state <br /> Has no home ID or X-plate because: Q Coming out of county deed records <br /> ❑ Other: <br /> Manufacturer:Golden State Model:Unknown Year:1994 <br /> Manufacturer serial number HUD number <br /> S9� l �Zt •. <br /> 114-o <br /> *Number of sections: . *Square footage: *Number of bedrooms: ALI *Number of bathrooms: Z <br /> Av�� i s hamk"\--e- <br /> *Type of roofing:5A}i yv f*Type of siding: 44 *Heating: *Cooling: <br /> J <br /> *Date of sale: Mpt,. f 2-07-7.- *Sales price: Li-71c DO 00 *Includes land: ❑Yes IgNo <br /> i, : � I :r +oar ^�i+s J` x.' <br /> DEALER INFORMATION (if no dealer, leave Marti <br /> Dealer name: Dealer license number: Dealer address and phone: <br /> ❑Thismanufacturedstructure 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 penalty for perjury. <br /> Dealer name(print): Dealer signature: Date: <br /> a _� .r., xuf�i - _. <br /> 4 ' TRAM PORTER4INF'ORMATION if n®t rrro�ving Iear a tt ank F��„$ �% ,kyr <br /> Transporter name: Transporter address an p e: <br /> �'o.�o� \-\v-v‘3,1‘,\ v�,3-1` t aa--13 Y\ ''kk <br /> .6-VLVv 5v1 1\-e— © at <br /> 440-2952(7/19/COM) Page 2 <br />