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B 8 flL( 0 Lcvner 7 3 q <br /> NATURE OF FILING (check all that applies) <br /> Niaar(gs'Orie-in-Inest El Change ownership e <br /> e i t ai op trty •n • • n t, s atts ®❑Trip permit o ei t t�tc est�rage <br /> ESA r: . <br /> APPLICANT INFORMATION <br /> El Dealer/seller ❑Lender ❑Escrow/title agent ❑ Owner/buyer ❑ Legal representative <br /> Name: CASCADE FACTORY HOMES INC <br /> Address(including city,state,and ZIP): 590 N PACIFIC HWY,WOODBURN OR 97071 <br /> Phone: 503-981-5314 • <br /> Email: CASCADE FACTORY HOMES <br /> HOME INFORMATION (*required) <br /> Home ID number(if known): DMV X-plate number(if known): jj <br /> ❑Moving in from another state ( 53b1 I <br /> Has no home ID or X-plate because: ❑Coming out of county deed records <br /> ❑ Other: <br /> Manufacturer:Palm Harbor Homes Model:W128684W Year:2023 <br /> Manufacturer serial number HUD number <br /> PHH3100R21-14473A ORE 558670 <br /> PHH310OR21-14473E ORE 558671 <br /> *Number of sections:2 *Square footage:1,836 *Number of bedrooms:4 *Number of bathrooms:2 <br /> *Type of roofing: ARCH SHING *Type of siding: CEMENT *Heating:ELECT *Cooling:N/A' <br /> *Date of sale:2/7/2023 *Sales price:$150,107 *Includes land:❑Yes ®❑No <br /> DEALER INFORMATION (if no dealer, leave blank) <br /> Dealer name: Dealer license number: Dealer address and phone: <br /> CASCADE FACTORY HOMES INC MSD-41 590 N PACIFIC HWY <br /> WOODBURN OR 97071 <br /> 503-981-5314 <br /> OThis 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 si nature: Date: <br /> CASCADE FACTORY HOMES INC \A, 2/7/2023 <br /> TRANSPORTER INFORMATION (if not moving, leave blank) <br /> Transporter name: Transporter address and phone: <br /> SUPERIOR HOME TRANSPORT LLC PO BOX 1067 JEFFERSON,OR 97352 <br /> 503-551-3454 <br /> 440-2952(7/19/COM) Page 2 <br />