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606504
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Last modified
3/24/2023 10:00:04 PM
Creation date
3/22/2023 8:19:53 AM
Metadata
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Template:
Assessor
Account Number
606504
Assessor Doc Type
Trip Permit
Secondary Assessor Doc Type
Jacket
Doc Type Date
3/21/2023
MTL
082W06AC02600
Assessor Section
Manufactured Structures
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MANUFACTURER'S STATEMENT OR CERTIFICATE OF ORIGIN TO A MANUFACTURED HOME <br /> - FIRST ASSIGNMENT <br /> MANUFACTURER: Fleetwood Homes,Inc. For Value Received,the undersi ed h transfersthis Statement of Origin and the manufactured <br /> . home described therei to: 63, 4,Sf5. LI-& <br /> ADDRESS: 2655 Progress Way,Woodburn,OR 97071 Addtess�? ) �,nr �(gv n ) " <br /> and certifies that the home is new and has not been registered in this or any other state;he also warrants <br /> Strew.,Co,State,and ZJp the title of said home at time of delivery,subject to the limas and encumbrances,if any,as set out below <br /> Amt�fLien Date To Whom Due Address <br /> The undersigned MANUFACTURER hereby certifies that the new manufzct red home described below, .11047 r �j ti <br /> the property of said MANUFACTURER,has been transferred <br /> y �:;or(Fin t. Sign ere Position <br /> this 22nd day of December - , 2022 on Invoice No 202268122300 Dealer•s ,, i^.. l��E <br /> ' .. n,a i- .• who by me being <br /> Beforo �-,:~�~,y- �r� <br /> duly sw `' •.oath s o ab e true and corect <br /> To: FACTORY HOMES CLEARANCE CENTER Subs MISS DieFi1?,r e rac 4§a? , <br /> Dimibutar,Dealer,Sic Notary Public for 4 j , Cofmty,State of ( : <br /> Whose Address is: PO BOX 2176 Notary Seat <br /> SECOND ASSIGNMENT <br /> Street For Value Received,the undersigned hereby transfers this Statement of Origin and the manufactured <br /> TUALATIN_OR 97062 home described therein to: <br /> Cry;Stare and Zip Address <br /> and certifies that the home is new mad has not been registered in this or my other state;he also warrants <br /> Trade Name: 210SPSandpointe-14522A Model Year: 2023 the title of said home at time of delivery,subject to the liens and encumbrances,if any,as set out below <br /> Amt.Of Lien Date To Whom Dee Address <br /> Model No: 210SP14522A Body Width Ft 13'8" <br /> Body Length Ft 56 0" /Ft 52'0" Dated , 3z <br /> By: <br /> Including Hitch EarhdurgHitch Transferor(Fran Name) Sips Here <br /> Position <br /> Square Feet 710 Date of Mant�acture: 12/19/2022 Dealer License(Permit)No. <br /> Before me personally appeared who by me being <br /> duly sworn upon oath says that the statements set forth above are true and correct <br /> Manufacturer's ID No: FLE210OR22 22968A Weight 24.130 Seibscirbed and sworn to before me this day of <br /> Manufacturer's ID No: Weight Notary Public for County,State of <br /> Manufacturer's ID No: Weif.fht Notary Seal <br /> THIRD ASSIGNMENT <br /> Manufacturer's ID No: Weight For Value Received,the undersigned hereby transfers this Statement of Origin and the manufactured <br /> Manufacturer's ID No: Weight home described thereinto: <br /> Manufacturer's ID No: Weight Address: <br /> and certifies that the home is new and has not been re steted in this or any other cram he also warrants <br /> the title of said home at time of delivery,subject to the liens and encumbrances,if any,as set out below <br /> The CORPORATION further Certifies that this was the first transfer of such new manufactured home in Amt Of Lien Date To Whom Due Address <br /> ordinary trade and commerce. - <br /> Fleetwood Homes,inc. Dated at <br /> BY: <br /> Corporation. ) p • Transferor(Errs Name) SipHe a PCSlrian <br /> 6Gc.C.,.,,7"-n 3 Lg, Dealer License(Permit)No. <br /> Be 1' Before me personally appeared who by me being <br /> Sin Name 771Ie or.Sition .• duly sworn upon oath says that the statements set forth above are true and correct. <br /> qqq 2655 Progress Way,Woodburn,OR 97071 - Subscribed and sworn to before me this day of <br /> Notary Public for County,State of <br /> . <br /> Office Address ofSignatory(City&State) Notary Seal <br />
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