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• <br /> • <br /> •4f Assessor's Office <br /> trotwt.AS 1036 SE Douglas Ave. Rm 206 <br /> COUNTY <br /> Roseburg, OR 97470. <br /> • (541)440-4222 MH@co,douglas.or,us <br /> • <br /> • • COUNTY CERTIFICATE <br /> 'Douglas County has received notice of Ownership Document Application for a manufactured home: <br /> NATURE OF FILING <br /> Location Change Al Owner Change Tr i vh CA- <br /> If.moving,proposed location;550 s�S�� (1A .L� a��tA..`M A in, of2-. <br /> APPLICANT INFORMATION <br /> • <br /> O .Dealer/Seller. 0 Lender ,i Escrow/Title Agent ❑ Owner/Buyer 0 Legal Representative , <br /> ,NAME:Vti rA...Amex co \ I'A le a.nc- D <br /> LAS tx C , L-Pcz-r) <br /> ADDRESS: 7"� S _OYYIY_Y1sCY'i Sir r sE Jl I SCdffYtt 3D <br /> PHONE:'1. nkr\r1S O n la.2ft<'SA kyY1, COYYI <br /> nn HOME INFORMATION <br /> HOME ID: OC€4o 3P.s DMV X-PLATE NUMBER: <br /> 0 MOVING IN FROM ANOTHER STATE 0 OTHER <br /> • ,13( COMING FROM ANOTHER COUNTY <br /> MANUFACTURER' j\dpy\\j) \- MODEL: U�f1,_►)t)tir'. YEAR: 1997 <br /> NUMBER OF SECTIONS: c . DATE OF SALE: SALE PRICE: <br /> Signature(Assessor or Representative) Printed Name <br /> P6 smera 1 :l1 4 I ► 3 <br /> Title Date <br /> This certification Is valid through: 5—( /D / <br /> • <br /> • <br /> Effective September 19,2017 <br />