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1 1 eCjeVS RJ L Y <br /> Dor-11819n Envelope ID:7DE93942-E9D6-4605-9331-F1728F900632 9- 1358 <br /> 1426932 <br /> Ir • TORE OF FILING. cha k all a•plies <br /> . 1 i�.,�• ►',,i 1.,y' , . <br /> g <br /> L a v v ,. kP per <br /> ;; mit n s cage <br /> APPLU ANT 1NFOR TION <br /> 0 Dealer/seller [J Lender 0 Escrow/title agent Owner/buyer �]Owner/bu _ ..Legal y : • <br /> Name:Laura P representative <br /> Address(including city,state,and ZIP}:11082 Tl <br /> ETERS <br /> Phone: ROADLYONS OR 97358 <br /> Email: <br /> • <br /> Home m number(aflaaox�a); HOME INFORMATION.* _ uirld) <br /> KIDMV X plate number(af known Os <br /> 0 Moving in from another state • C <br /> Has no home ID or X-plate because: ❑Coming out of county deed records C 5 ' (D <br /> 0 Other. <br /> Manufacturer:CLAYTON <br /> Model:CP 561)F' Year,2021 <br /> Manufacturer serial number <br /> HUD <br /> ALS0406130 : l number <br /> *Number of sections: Z, *Square footage: .- *Number of bedrooms:- �J Number of bathrooms: 2, <br /> Type of roofing:Ardri *Typeof siding: e t , tIieating: g(eCooling: '/ <br /> *Date ofsale: <br /> a Sales price: _ 51 .„8 *Includes land: Yes /No _ <br /> DEALER INFORM ION If no dealer,leave banks .� <br /> Dealer name: Dealer ,, ,t <br /> CLAYTONHOMES � ,OR • - DI 95 Dealer address and phone: <br /> CC B X165990 1437 CENTURY DNE <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 guy knowledge and beiief,and that I understand it <br /> is made for use as evidence in court andfs_subj_ r--to pet :Ity,for perjury. <br /> Dealer name iprint): <br /> l 4Dea1er <br /> /f Date: <br /> T 'NSPORTE iNFOR ' ION(if not moving,leave blank) t <br /> Transporter name: Transporter address and phone: <br /> _. rn.erni4dna errF 1 <br /> — <br /> -- <br /> 440.2952(1/19/COM) <br /> OR Title Application-10/2019-TitleAppl 1211 <br /> Paye 2 <br /> 004446092-00001 <br />