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cgqjan,se.,-, uoci. E •�61 <br /> ) , 10 0����n °I l <br /> SECTION 1' . NATURE OF FILING (check all that apply) <br /> 4 New borne to MHODS fg'.14k6IfiuC rrwgterDxag�'evwvmer 10 a u ,hti t a : ) <br /> aRvd'lumte..sale' Ef\RaFcrii7N,esFaLfrperty Ei/d tole t o e.la <br /> •u ' t fe 'i'a> EIN.R •u on ea op tus 0 Trip Permit <br /> tg"AT‘ ifilicritanee t s ): _. . .. <br /> SECTION 2 APPLICANT INFORMATION (please print) <br /> 0 Dealer/Seller ❑Lender ❑ Escrowii'itle Agent 0 Owner/Buyer ■❑Legal Representative <br /> Name: garble Phillips <br /> _(ji,ar;»riddle,last) p Phone:541-777-7835.:._ <br /> Address: 1999 Jansen Way#E2'. <br /> city: Woodburn State: OR [—ZIP: 97071 _ - : <br /> Email: <br /> SECTION 3 HOME.INFORMATION (Information in bold is required) ,_- <br /> Home ID#:. New OR No Home ID; ❑New Home 0 Out of state home 0 Leaving County Deed Records <br /> Manufacturer: Guerdon &7C)7g -/ ) <br /> Model: West Ridge <br /> I Year: 2023 <br /> Serial Number(s) <br /> HUD Label Number(s) *Required if new home <br /> 245-000-H-A-101340A6 ORE559250 / ORE559249 <br /> #of Sections: 1 Sq.footage: 1120 Bedrooms: 2 <br /> Bathrooms: 2 ` <br /> Roofing type:_ '.Corn : Siding e: m Coolinge: <br /> i Heating p g�1� T1-11 Heatin e: Heat Pump ts�p : Heat Pum <br /> Date of sale: p.; <br /> (/famlicable) 6 19=23 Sale price:. 15,590.00 Includes land: ❑Yes D No <br /> SECTION 4 DEALER INFORMATION (leave blank if no dealer) <br /> Name: <br /> (first,ntlrldle,lash License#: <br /> Address: <br /> City: State: ZIP: <br /> Email: <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 orimy 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 /> SECTION 5 <br /> i HOME LOCATION °' <br /> Current Address: 550 Both Bend Road <br /> City: McMinnville County: Marion State: OR zip <br /> : 97128 <br /> Park Name: Of applicable) Woodburn Senior Estates <br /> ❑This is a dealer lot or storage facility <br /> ❑This home is being'moved to a new location Complete the section below <br /> New Address: 1999 Jansen Way NE i <br /> Sp 10 <br /> City: Woodburn I County: Marion I State: OR Zip: 97071 <br /> Park Name: (if applicable) Woodburn Senior Estates <br /> ❑This is a dealer lot or storage facility <br /> Transporter Name: v 99. (° �,p 5 �� Phone: �j f <br /> Address: „I/lb r-�� �'r\ �''•�..^' �y� 7eJ,J <br /> t'tr b ress c��- -t City. <br /> Email oar t'Y� State: (7 crib-7 <br /> Page 2 <br />