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Aq 15 SAO e I'e R kie4D_ <br /> NATURE OF.F1LING,. check all that a lies, <br /> �,, a apphes), <br /> � <br /> 1/NcylikkiseaVt\ipt'elest 0 Change ownership oh n oli ' is <br /> Q tcc rdin s r pro o 'nor e t sta ua 0 Trip permit ' i rt o f a e <br /> then: <br /> APPLICANT INFORMATION <br /> ❑Dealer:iseller ❑Lender ❑Escrow/title agent Q Owner/buyer ❑ Legal representative <br /> Name: Amber Homes LLC <br /> Address (including city,state, and ZIP): 221 Main St#2039, Los Altos, CA 94023 <br /> Phone: (919)800-8164 <br /> Email: jack.walls@amberhomes.us • <br /> • <br /> HOME INFORMATION (*required) <br /> Home ID number(if/mown): DMV X-plate number(if brown): • <br /> 275903 Cob a5 5 <br /> nMoving in from another state <br /> Has no home ID or X-plate because: ❑ Corning out of county deed records <br /> I I Other: • <br /> Manufacturer: Redman Model: Unknown Year: 1994 <br /> Manufacturer serial number HUD number <br /> • <br /> 11819334AB ORE 250220/ORE 250221 <br /> *Number of sections: 2 *Square footage: 1,232 *Number of bedrooms: 3 *Number of bathrooms: 2 <br /> *Type of roofing: Metal *Type of siding: Metal *Heating:Central *Cooling:Central • <br /> *Date of sale: 05/31/22 *Sales price: 556,000 *Includes land: ❑ Yes rj No <br /> DEALER INFORMATION (if no dealer, leave blank) <br /> Dealer name: Dealer license number: Dealer address and phone: <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 is <br /> made for use as evidence in court and is subject to penalty for perjury. <br /> Dealer name (print): Dealer signature: Date: <br /> TRANSPORTER INFORMATION (if not moving, leave blank) <br /> Transporter name: Transporter address and phone: <br /> 440-2952(7'19.,CoMt) Page 2 <br /> Doc ID:98b2cdlde9bac59fded63cd30040986f4686bae4 <br />