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2 0 i4--‘ I . b-\-- De-X1-1,--, 0\-Z - q <br /> DocuSign Envelope ID:9B4E1 DAC-5DC4-4D7B-A3DA-D66E27A19A1 F <br /> 148I727 <br /> NATURE OF FILING(check all that applies) <br /> ❑Change security interest 1 0 Change ownership ID Demolition Dale of demolition: <br /> ❑Recording as real property 0 Removing from realstatus <br /> I property Tiip Permit I Q Converted to storage <br /> ❑Other: <br /> APPLICANT INFORMATION <br /> 0 Dealer/seller 10 Lender 10 Escrow/title agent I Q Owner%buyerI0 Legal representative <br /> Name:Lame Pattyn and Michael Vetter <br /> Address(including city,state,and ZIP):220 HILL ST DETROIT OR 97342 <br /> Phone: <br /> Email: <br /> HOME INFORMATION(t required) <br /> Home ID number(if known): X plate number(:f known): <br /> Ev <br /> Q JDMV Nt <br /> 0 Moving in from another state L '°`+ 605(4;1 , <br /> Has no home ID or X plate because: ❑CO's out of county deed records <br /> Q Other: <br /> Mangy:CLAYTON Model:DRM482F !Year:2022 <br /> Manufacturer serial number <br /> map nmmbet <br /> ALB0416420RAB <br /> "Number of sections: '. J*Square footage:1,I J*Number of bedrooms: J*Numlber of bathrooms: "2– <br /> * <br /> Type of roofing I r b l'Iln:/*!ype of siding. 1 Wei) *Heating: E� .( J*cooling: <br /> *Date of sale:1 L.(t 72_, *Sales price: Z.24 t-�a.)— *Includes land: D Yes Ergo <br /> DEALER INFORMATION(If no dealer,leave blank); <br /> Dealer name: Dealer license number: Dealer address and phone: <br /> CLAYTON HOMES ALBANY,OR <br /> DLR #MSD195 1437 CENTURY DRIVE NE <br /> CCB #166990 ALBANYOR97322 <br /> (S41)967-8555 <br /> 0 This manufactured stricture 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 /> Dl er name(print):` Dealer signature: <br /> 1`-- ��DY` '� kiR i �- �� Y11.� Date.- fY'IO kurcbai 1/2422- <br /> TRANS <br /> RMATI (if not movin leave <br /> Transporter name: a blank) <br /> Transpo er address and phone: <br /> b- nr 1 Crfir tAr.otO - X153 <br /> 440-2952(7/19/COM) <br /> OR TitIc Application-10/2019-TitleApp11211 <br /> 2 004589979-00001 <br />