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`T7 7 5 <br /> 0 ey Rot SL- IT); ti ---73(cO <br /> 1496272 <br /> NATURE OF FILING (check all that applies), <br /> e e tlisiifttgp sDjoThegsevrtipA, <br /> 1 n <br /> X4rip permit a v e o storage <br /> 'Other: <br /> • APPLICANT INFORMATION <br /> ID Dealer/seller I Q Lender Escrow/title agent 111 Owner/buyer Legal representative <br /> Name:Jered Moberg and Jessica Murphy <br /> Address(including city,state,and ZIP): 27750 RIVER ROAD SE MILL CITY OR 97360 <br /> Phone: <br /> Email: <br /> HOME INFORMATION (*required) -- <br /> Home ID number(if known): 1DMV X-plate number(if known): <br /> SEA <br /> Moving in from another state <br /> Has no home ID or X-plate because: ❑Coming out of county deed records <br /> Other: <br /> Manufacturer:CLAYTON f Model:DRM601F lYear:2023 <br /> Manufacturer serial number I HUD number <br /> ALB042169ORA13 <br /> *Number of sections: 7 *Square footage: 1*Number of bedrooms: t\ *Number of bathrooms: <br /> 2. <br /> *Type of roofing:j '(Y *Type of sidin T: <br /> 1 , b rrLs vt),, �� Heating: e1 ex_ *Cooling: <br /> *Date of sale: l4 \\\f 2) *Sales price: \ l *Includes land: (l Yes o <br /> DEALER INFORMATION (if no dealer, leave blank) <br /> Dealer name: Dealer ' • Dealer address and phone: <br /> CLAYTON HOMES ALBANY,OR DLR #MSD195 1437 CENTURY DRIVE NE <br /> CCB #166990 ALBANY OR 97322 <br /> (541)967-8555 <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 <br /> is made for use as evidence in court and is subject to penalty for perjury. <br /> Dealer name(print): Dealer signature: <br /> Date: <br /> TRANSP TER INFORM ON If not moving, leave blank) 1 IS � <br /> Transporter name: Transporter address and phone: <br /> 440-2952(7/19/COM) <br /> OR Title Application-10/2019-TitleApp 11211 Page 2 <br /> g 004664330-00004 <br />