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1 Jr: ' <br /> .. - Gounlor e /' <br /> % <br /> . Finonca•pr: 0 3 4 5 <br /> As. <br /> ' 1 <br /> i , .. ,ct , w\:)., <br /> DA N()Y k Sccn-L, )4 13 6c-/-1 - <br /> ; CTION 1 NATURE OF FILING(check all that apply) <br /> 0 New home to MHODS ❑ 0 Demolition(Date:Adding or removing a co-owner ) <br /> _ <br /> • <br /> ► .Used home sale ~ 0 Recording ns real property ❑ Convened to storage <br /> ❑ Security interest change ❑ Removing from real property status Trip Permit <br /> ❑ Transfer by inheritance ❑ Other(please note): <br /> SECTION 2 APPLICANT INFORMATION(please print) <br /> 0 Dealer/Seller 0 Lender 0 Escrow/Title Agent 0 Owner/Buyer ❑Legal Representative <br /> Name: l�A R� 1 1 ��A � <br /> (fist.middle,last) VtV RA[ N Phone: e5/3_9/6 — <br /> Address: c ('j t B,;6_, c_y f- �7 / <br /> City: T -R��C7� I I State: 0 Q I ZIP: l7 L wO <br /> Email: CARsot.kc REA.142 &- ,COI, <br /> SECTION 3 HOME INFORMATION(information in bold is required) <br /> Home ID tl: a,U!i co -7 44 OR No Home ID: ❑New I tome ❑Out ofstatc home 0 Leaving County Deed Records <br /> Manufacturer: Fd(ALIA <br /> Model: 205(.{.QJ Year: l a <br /> Serial Numbers) I ij 2_50 }IUD Label Number(s) 'Required if new home <br /> 1 <br /> 1 <br /> N of Sections: <br /> Z- Sq.footage: I ('H. Bedrooms: 3 Bathrooms: Z <br /> Roofing type: ��'tipt T Siding type: T( -11 Heating type: NV& Cooling type: ( 4/, <br /> of sale: �►' <br /> (/Joytvlkoble) 1/� Sale price: $Ejpoo Includes land: 0 Yes XNo <br /> '-SECTION 4'•'. - DEALER INFORMATION(leave blank if no dealer) <br /> Name: I <br /> first.middle,lost) License II: <br /> Address: <br /> City: I 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 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: i <br /> 1 Date: <br /> VSEC O,�N:S;j '} .:1 ,• .,z ,;.' 'HOME LOCATION <br /> Current Address: <br /> (00 2_20 Pr >NStlir.e. LAPSE <br /> r <br /> City: t,tt, County: 0� I <br /> I Da:-�,CN IJS I State: 9770z, <br /> I Park Name:(ijapplicable) <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 /> illiN•ew„yAdd ess:;;tH // 2_45 V 1 . J1kiJ 11 kR Ek.s 1 <br /> otGityi C P jE I I'County:r NilkRIOt4 OQ ( - Zip: <br /> State: p; G��� ,f <br /> Park Namc:(if applicable) <br /> "1�0 <br /> 0 This is a dealer lot or storagerfacility <br /> •t.r hspolrterN me:j Luc - LUVJ.E 13 <br /> � _ _ '2 t�lr� � N 1-5� b r�,,1eD .. '-t»• e: 54.1- 2►3— 1 551 <br /> E l City: ' t i.. : /Stater .-. e " .77 <br /> brn.vE <br /> asp • . di i , CO. ,& ... <br /> %. <br />