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•_ , , _ <br /> U <br /> ,-� q -7. 3 4 D- <br /> NATURE OF FILING (check all that applies) <br /> ► . '1� se• n• in •r _ C ig le : •p r, De •. i ton I - •• e-mo . <br /> 2 Re rdit rea - erty- `en . tng a • ; ❑■ Trip permit i e- to o p, <br /> E.Othcr: <br /> APPLICANT INFORMATION <br /> 0 Dealer/seller ❑ Lender ❑ Escrow/title agent ❑ Owner/buyer ❑ Legal representative <br /> Name:LEISURELAND HOMES INC <br /> Address(including city,state,and ZIP): 33964 OAKVILLE RD SW ALBANY OR 97321 • <br /> • Phone:541-928-1555 • <br /> Email:mindy2lm@comcast. net <br /> HOME INFORMATION *re uired <br /> ( q ) <br /> Home ID number(if known): DMV X-plate number(if known): <br /> NEW (00 1a <br /> )Moving in from another state an 5C l`�D-40 <br /> Has no home ID or X-plate because: n Coming out of county dccd records <br /> n.Other: NEW <br /> Manufacturer:FLEETWOOD WESTON Model:28502L Year:2022 <br /> Manufacturer serial number HUD number <br /> FLE210OR21-21891 A& B ORE 556627 <br /> ORE 556628 <br /> *Number of sections: 2 *Square footage:1333 *Number of bedrooms:2 *Number of bathrooms:2 <br /> *Type of roofing:ARCH • *Type of siding:CEMENT *licating:ELEC *Cooling:NONE <br /> *Date of sale:06/0612021 *Sales price:120,278.00 p Includes land: ❑ Yes No <br /> DEALER INFORMATION (if no dealer, leave blank) <br /> Dealer name: Dealer license number: Dealer address and phone: <br /> LEISURELAND HOMES INC. MSD 119 33964 OAKVILLE RD SW ALBANY OR <br /> 97321 <br /> 541-928-1555 <br /> • <br /> El 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 o ledge and belief, and that I understand it is <br /> made for use as evidence in court and is subject to penalty for pe jur . <br /> Dealer name (print): Dealer sig at e: Date: <br /> LEISURELAND HOMES INC (9 73 ��� <br /> TRANSPORTER INFORMATIO. (if not moving, leave blank) <br /> Transporter name: Tra sporter address and phone: <br /> LEISURELAND HOMES INC 33864 OAKVILLE RD SW ALBANY OR 97321 <br /> 541N28-1555 <br /> 440-2952(7/19/COM) Page 2 <br />