Laserfiche WebLink
r } <br /> • 360 Cera-l-rat ANIE - , Ga-te5 b I(KJ` 9 -7 3 4 <br /> 1406783 <br /> ATURE:OF FILING (check allthatapplies) <br /> a e nt:itflterest Change ownership 1-41D ri e i ,• s -- o' ie Aisle. <br /> V • c r-.. . o.- ► 'e u ov',g ... . r . .. . L. - _6: rip Permit Argn t t as rage <br /> 51,0ter: <br /> APPLICANT INFORMATION <br /> Dealer/seller Lender Escrow/title agent El Owner/buyer Li Legal representative <br /> Name:Ray Guffiford and Paula Gulliford <br /> Address(including city,state,and ZIP):360 E CENTRAL AVE MILL CITY OR 97346 <br /> Phone: - <br /> Email: <br /> HOME INFORMATION (*required). <br /> Home ID number(if known): E DMV X-plate number(if known): b&1?9 <br /> Moving in from another state LSI 1(014) <br /> Has no home ID or X-plate because: ❑Coming out of county deed records <br /> Other: <br /> Manufacturer: CMH Model:BREEZE 2.5 Year:2021 <br /> Manufacturer serial number HUD number <br /> ALB040062ORAB <br /> *Number of sections: *Square footage:/ L.L./ *Number of bedrooms: `7) *Number of bathrooms: Zi <br /> *Type of roofing: 61,17,5 *Type of siding: *Heating: *Cooling:, <br /> *Date of sale: //y/'-2) *Sales price: (5-3 0 *Includes land: El Yes [ No <br /> DEALER INFORMATION (if no dealer, leave blank) <br /> Dealer name: Dealer license number: Dealer address and phone: <br /> CLAYTON HOMES ALBANY,OR DLR #MSD195 1437 CENTURY DRIVE NE <br /> CCB #166gg0 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 a e: Date: <br /> C� 1Ihll 2d?A <br /> TRANSPORTER INFORMATION (I of moving, leave blank) <br /> Transporter name Transporter address and phone: L--47/... <br /> 13244a5 b 'JFe n 0P. q135. -- <br /> 440-2952 <br /> 0-2952(7/19/COM) <br /> OR Title Application-10/2019-TitleApp11211 Page 2 004372391-00001 <br />