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DccuSign Envelope ID:6288A8A9-9556-4D46- 31950ED5F1 E2 <br /> 3449988 a -At 5 Cen1-ey S <br /> NATURE OF FILING(check all that applies) <br /> lieanaseaottfinteks, rjalionftval:§1AP'1' <br /> alearsliees-fisqyrollgreY tglitAgiAltraintrg4ituk, , TriP permit ` J tied to e <br /> Cer: <br /> APPLICANT INFOR ' 'ON <br /> El Dealer/seller Lender El Escrow/title agent ►m Owner/buyer Legal representative <br /> Name:Patrick West and Vlckey West <br /> Address(including city,state,and ZIP):245 CENTER ST DETROIT OR 97342 <br /> Phone: <br /> Email: <br /> HOME INFORMATION (*required) <br /> Home ID munber(f known): DMV X plate number(if known): <br /> v� (DO Co-b 4 <br /> []Moving m from another state <br /> Has no home ID or X plate because: ❑Coming out of county deed records <br /> ❑Other: <br /> Manufacturer:CLAYTON Model:DEM661N Year:2022 <br /> Manufacturer serial number <br /> HUD number <br /> ALB041838OR <br /> a <br /> *Number of sections:(-- *Square footage:t I62 *Number of bedrooms:3 *Number of bathrooms: <br /> *Type of roc � i *Typesiding:cat2 t 1101-*Heatuag:e lm-z1'a c. *Cooling: (-) <br /> *Date of sale: 1 117 i 20 Z' ,.- *Sales price: (} ,0° *Includes lead: []IrosiMiTo <br /> DEALER INFORMATION(If no dealer,leave blank) <br /> Dealer name: Dealer license number: Dealer address and phone: <br /> CLAYTON HOMES ALBANY,OR wICt 6 1437 CENTURY DRIVE NE <br /> 1 I ,A - ALBANY OR 97322 <br /> �V (,� (541)9674SM <br /> 0 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 <br /> Is made for use as evidence in court and is subject to penalty for perjury. <br /> Dealer name(print): ,--D erA l}ature: Date: <br /> Clayton Homes 11 11/4/2022 <br /> TRANSPORTER INFO-"s , ' ' (If not moving,leave blank) <br /> rensporter name: Transporter address and phone: ,5-1,4 �`r LI, <br /> fli / k.o f-wp <br /> 440-2952(7I19/COM) <br /> OR Idle Applies-102019•TdleApp11211 Page 2 <br /> 004526469.00006 <br />