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02/14/2014 10:26PM 7653810935 PAGE 01/04
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<br /> ❑Change security interest 0 Change ownership , ❑Demolition Date of demolition:
<br /> El Recording as real property ❑Removing from real property status 0 Trip permit ❑Converted to storage
<br /> • ❑Other:
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<br /> Q Dealer/seller ❑Lender ❑Escrow/title agent ❑ Owner/buyer ❑ Legal representative
<br /> Name:ADVANCED HOME BROKERS, INC.
<br /> : • .Address(including city,state,and ZIP):10762 S.E. HWY.,212 CLACKAMAS, OREGON 97015
<br /> •Phone:503-650-0304
<br /> Email:john@a-h-b.com
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<br /> Home ID number(if known): DMV X-plate number(if known):
<br /> 397644_ .:.....: V
<br /> ❑Moving in from another state 0. 9 B a o.)j
<br /> . Has no home ID or X-plate because: ❑Coming out of county deed records
<br /> •
<br /> ❑Other:
<br /> Manufacturer:FLEETWOOD Model:LAKEVIEW Year:2019
<br /> •:`°'Manufacturer serial;number :'° HUD number
<br /> • FLE2100R1919716A • ' ORE 546066
<br /> •
<br /> •
<br /> *Number of sections:1 *Square footage:592 *Number of bedrooms:I *Number of bathrooms:I
<br /> •
<br /> *Type of roofing:COMP *Type of siding:HARDY *Heating:ELECTRIC *Cooling:A/C
<br /> *Date of sale:06-10-2022 *Sales price:$71,000.00. *Includes land: ❑Yes El No
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<br /> • Dealer name:. Dealer license number: Dealer address and phone:
<br /> ADVANCED HOME BROKERS, INC. MSD-579 10762 S.E. HWY.212
<br /> CLACKAMAS, OREGON 97015
<br /> •
<br /> 503=650-0304
<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 s my knowledge and belief,and that I understand it is
<br /> • made for use as evidence in court and is subject to penal ,r perjury.
<br /> • Dealer name(print): De.4: igna Date:
<br /> ADVANCED HOME BROKERS, INC. (.' /�J
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<br /> 22k-
<br /> 3i '"'it $0,41; u_Ax.s C'i, '. r4tUr y:dr.t.3=giVIVI R i b ' `�`i'f"K •�1:-t x s '• t+lL:..::'(?S`U Y,* °'..ih i 3 .,+7 c, -S r ca
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<br /> Transporter name: Transporter address and phone:
<br /> CT WILSON. • • PO BOX,652
<br /> LYLE,WASHINGTON 98635(541)980-5711
<br /> •
<br /> 440-2952(7/19/COM) Page 2
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