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e°pJs,,P <br /> ,, w Financa,OR <br /> 4 5 NOCountor // / <br /> v <br /> A t <br /> , , <br /> c Y k-\--)Sax)�►c�o ') VI `3 <br /> aCTION 1 NATURE OF FILING(check all that apply) <br /> ,= ❑, New home to MHODS 0 Adding or removing a co-owner 0 Demolition(Date:_ ) <br /> s'"* Pi .Used home sale <br /> ❑ Recording••is real ❑ Converted to storage. <br /> 1 ❑ Security interest change ❑ Removing from real property status Trip Permit <br /> ,- 0 Transfer by inheritance 0 Other(please note): <br /> SECTION 2 APPLICANT INFORMATION(please print) <br /> 0 Dealer/Seller 0 Lender ❑Escrow/Title Agent ❑Owner/Buyer ❑Legal Representative <br /> Nam KA.R.y1\1 E � <br /> (first middle.last) Phone: �3.��D.. � <br /> Address: `I (1 t eltA BIG &y PL. <br /> ,.. City: y.7,. 45 State: te ZIP: 977 6,0 <br /> Email: C t. E•V.142. ,Cohk <br /> SECTION 3 HOME INFORMATION(information in bold is required) <br /> Home ID#: - ,3 4 Co'7.4 OR No Home ID: 0 New Home ❑Out of state home 0 Leaving County Deed Records <br /> Manufacturer: r't3 ail A <br /> Model: iL tone, <br /> —I �? Year: <br /> Serial Number(s) 14,250 HUD Label Number(s)*Required if new home <br /> i <br /> #of Sections: Z Sq.footage: 1(L.}-4 Bedrooms <br /> • 3 Bathrooms: 2._ <br /> Roofing type: f hf Siding type: T-1 -I l Heating type: t'4//S,a Cooling type: 44, <br /> Date of sale: <br /> (fayptrcabte) / Sale price: *5000 Includes land: 0 Yes No <br /> *SE,CTION 4 w :'e DEALER INFORMATION(leave blank if no,dealer) <br /> Name: <br /> Urst,middle,last) License#: <br /> Address: <br /> City: I State: ZIP: <br /> Email: t <br /> 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: <br /> Date: <br /> ,.; HOME LOCATION <br /> Current Address: to 2_2.0 pAdy\s14>�e L4 t4 . <br /> City: EtAb I County: D SCI_uTas l State: DR__ I Zip: 770 .- <br /> Park Name:(if applicable) <br /> 0 This is a dealer lot or storage facility <br /> is home is;being moved to a new location Complete the section below <br /> N e`.t dt mess fff 2_f`5 NI. aPtl.Zt t(k.tA eks"c <br /> u4,Ca • C pc Coui 1 <br /> ylmh.RiOlk r State I:..De_ p: <br /> (if Name: applicable) Zip <br /> x. . aa 0 This is a dealer lot or storage facility <br /> t ;, a Willi-e 1�5 Loze. 13 Tfi L V MJDt) , x"t ;ne <br /> , 11 „ Sit- 213— 1�; <br /> l Odd s: • '2_.. W ► ./ <br /> ��r '�:.:- �i � �� !,. City: ..' , sr. : .State:. _� i. - 77 <br /> x. <br /> OaNCI b PI•Ve r • r ttL, , Cot& 4 <br /> L <br />