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• • <br /> f Y' <br /> DoCuSign Envelope ID:BC82F0C2-F6EE-4ECL J038-F05F91E29D16 <br /> 1447112 301-9-Li Lo 4 V.or\C\T - \ in <br /> 0Z'17-351 . <br /> MATURE OF FILING (check all that applies) _ VV <br /> IllEirargrsupuityinterest 1Change ownership. E.DElnak#le8—P$t� demoliticuu. \ <br /> -1E—Other's------- <br /> APPLICANT <br /> kk <br /> APPLICANT INFORMATION . <br /> 0 Dealer/seller 10 Lender 0 Escrow/title agent 0 Owner/buyer l Q Legal representative <br /> Name:Robert Johnstone <br /> Address(including city,state,and ZIP):32246 NORTH FORK RD LYONS OR 97358 <br /> ,Phone: — j <br /> Email: — I <br /> HOME INFORMATION (*required) <br /> Home ID number(if known): DMV X-plate.number(f known): too 3 L 6 <br /> IE]Moving in from another state <br /> Has no home ID or X-plate because: ❑Coming out of county deed records ~� <br /> Other: <br /> ___..__, <br /> Manufacturer SKYLINE MCMINNVILLE (Model:RAMADA VALUE jYear:2020 <br /> Manufacturer serial number I HUD number <br /> 245000HA100368AB - __ <br /> Number ofsections: ,� fSquare footage: �pp *Number of bedrooms: Number of bathrooms: II— <br /> I is <br /> *Type of roofing: A e(I s a+9. *Type of siding: L c)7►..t9 2+ j*Heating:E i e c}-�i c *Cooling: <br /> 1*Date of sale: 10)19 1-2 c-a.1 l*Sales price: iib 61i ii !*Includes land: 11Yes ®No <br /> DEALER INFORMATION (if no dealer, leave blank) <br /> Dealer name: Dealer license number: Dealer address and phone: <br /> CLAYTON HOMES ALBANY,OR 'n� 1437 CENTURY DRIVE NE <br /> 1 r 1 S 0 1 �5 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 bes o my knowledge and belief,and that I understand it <br /> is made for use as evidence in court and is subject to-penalty i' perjury. <br /> Dealer name(print): D aler signa••r, • Date: <br /> 1 � <br /> C,\Al400 ® 1f Y1 c-..5ti �-`-1. 10/11/4-24 <br /> TRANSPORTER INFORMA ON (�ct moving,�eave blank) <br /> Transporter name: Transporter address and phone: S Lig _ 3 Q--1... 7 so s- <br /> ofe.rIor- Nom ...`ry-Alvsjoj)el- 37 'v 6+L C eir..s 0 iv 6R <br /> 91 3.59. <br /> 440-2952(7/19/COM) <br /> OR Title Application-10/2019-TitleApp11211 Page 2 004489498-00002 <br />