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mil 1 Co D �N 0 VIA") 3c04% eL rn )4‘,0`, 3L-.1 r)f)j-- n ci--1,) . . . , <br /> SECTION 1 NATURE OF FILING(check all that apply) <br /> + tiJ DS <i r r rnow`tugra rfer ) <br /> Used home sale ]- ;et E.}r'eg-x,r�erl�pretp a: rt des ' . <br /> • • Se *iuir nestcla, ge Removing from real property status Trip Permit <br /> - _. us fer y-i> itance ® Other(please note):MOVING OUT OF CLACKAMAS COUNTY <br /> .SECTION 2 ' APPLICANT INFORMATION (please print) - - .. - . <br /> . •- .(Dealer/Seller ❑ Lender ❑ Escrow/Title Agent ❑Owner/Buyer ❑Legal Representative <br /> . t . <br /> Name:,: _. Phone: <br /> (first middle.last) PH,t t,P Nn,t_-,c,t ez.--y c w r 4.--si 5t_,\.�,.__.1- 1.`lI 3 <br /> Address: 17V9-, S n...tow�g ,'J`> ‘72,Cot_- f... a_r? <br /> City: t--t. r-LLJA State: �._ ZIP: 0 3 <br /> Email: P+►c_H tJs�.y C-,t--t-,t.... fo r---t <br /> SECTION 3 . HOME INFORMATION (information in bold is required) . <br /> Home ID it: X icy s—i S t OR No Home ID: E New Home ❑Out of state home Leaving County.Deed Records <br /> Manufacturer: 1Y,,, -r-1-1,.._. `-,o,--t1_..5 . ,...S--. . .. <br /> Model: as? Zo Year: 1°19--t <br /> Serial Number(s) HUD Label Number(s) *Required if new home <br /> ->‘ - r7tc.- 1�1 ( lam 60`7-eilb (5ii ia0-1(:� <br /> ::#,of'Sections-• 2 *Sq.footage: i 2 (2i) Bedrooms: Bathrooms: Z. <br /> Roofing type: Siding type: j 'I/?) Heating type: E 1�`�=.l�'1L- . Cooling type: .•(rr2 �:'C c: <br /> d" CI - <br /> Date of sale: U c <br /> - afapplicabie)- S Z Sale price: Includes land: II]Yes k No _ ._. ' <br /> .-_SECTION 4 . • . _ DEALER,INFORMATION (leave blank if,no dealer) -_ - . <br /> Name: License #: -. <br /> (first, middle, last) <br /> Address:- <br /> City: State: ZIP: <br /> Email: Phone: <br /> I hereby declare 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 or my interest in it. The information listed is true to the best of my knowledge and <br /> belief,and I understand it.can be used as evidence in court and is subject to a penalty of perjury. <br /> Signature: Date: <br /> .S,ECTION.S , • . , _HOME,LOCATION <br /> Current Address: 377Lia . nlo,ale,05 iJr ?A <br /> City: floklto., County: G1A(kaelA5 State: i0 I. Zip: 4170.36) <br /> Park Naine: (if applicable) ❑This is a dealer lot or storage'faciliiy <br /> ®This home is being moved to a new location Complete the section below <br /> New Address: 27760 5A-liia,---N 7 <br /> City: lit Li 4_i't County: / 0\.rlo\ State: 0 Zip: 973d0 <br /> Park Name: (if applicable) ❑This is a dealer lot or storage facility <br /> Transporter Name: 4 -!- j c <t nq Phone: Sy/ -2/3 - lSs 1 . <br /> Address: . 2`7 AN lE 1 r it Ave- 5fie 3 City: 2ed`r104 State: 07. . . - . _ <br /> . Email: o.''ilA "NGk',' 5 5SL1/0 6,4-40 1. C4,-'\ <br /> Page 2 . <br />