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• 3 1 1 01 ctor PO R d , S - 1 vey-toe) <br /> - - <br /> 111 New home to MHODS LinValtagZoratiolbagvnattler CAPetvIitraamii <br /> NAS2vIliekaosait c"gkradartils.taliSaverty 'Kirt-cOni rfetrbst67a-ge <br /> V\ii(c116:\itrAparldge °I;INFethanagnsptiNeriNesEty-status E Trip Permit <br /> ON.T•eafertitv,ilihcitsiage K/lOtka(nlemil.o&IN <br /> APPI4cANT INFORIVIATION(please print) .: - , • <br /> E Dealer/Seller El Lender El Escrow/Title Agent El Owner/Buyer El Legal Representative <br /> (first. a <br /> middNaimse;)ADVANCED HOME BROKERS, INC. Phone:503-650-0304 <br /> Address:10762 S.E. HWY. 212 <br /> City:CLACKAMAS State:OREGON ZIP:97015 <br /> Email:johnabraham1958@gmail.com <br /> -sEcripR 3 • HOME INFORMATION(information in bold is required) • <br /> Home ID#:N tuj .40 0 9,‘ OR No Home ID: El New Home ['Out ofstate home El Leaving County Deed Records <br /> Manufacturer:PALM HARBOR L - 5 _13.4 <br /> Model:UNKNOWN Year:2001 CoO435O-, <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> PH204717 ORE 415880 <br /> PH204717 ORE 415881 <br /> PH204717 ORE 415882 <br /> #of Sections: 3 Sq.footage: 2055 Bedrooms: 4 Bathrooms: 2 <br /> Roofing type: COMP Siding type: T-1-11 Heating type: ELECTRIC Cooling type: NONE <br /> Date olicablf sale: 07-15-23 Sale price: $59,950.00 Includes land: El Yes E No <br /> (If-appe) <br /> SECTION 4 DEALER INFORMATION(leave blank if no dealer) - <br /> (firstmiddleName:last)ADVANCED HOME BROKERS, INC. License 1#:MSD-579 <br /> , , <br /> Address:10762 S.E. HWY. 212 <br /> City:CLACKAMAS State:OREGON ZIP:97015 <br /> Email:johnabrahaM1956@gMail.COM Phone:503-650-0304 <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 mAnufacture$1strOure 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 uied,as pvidence in court and is subject to a penalty of perjury. <br /> Signature: , /4 1/ /,q-/1/4 ; Date: 3t2/1 <br /> -1-10414.E LOCATION <br /> Current Address:12604 REO RD.S.E. <br /> City:RAINIER County:THURSTON State:WA, I Zip:98576 <br /> Park Name: (if applicable) El This is a dealer lot or storage facility <br /> CI This home is being moved to a new location Complete the section below <br /> New Address:3871 VICTOR POINT RD. N.E. <br /> City:SILVERTON County:MARION State:OR, Zip:97381 <br /> Park Name:(if applicable) El This is a dealer lot or storage facility <br /> Transporter Name:CT WILSON Phone: 541-980-5711 <br /> Address:PO BOX 652 City: LYLE State: WA. <br /> Email: <br /> Page 2 <br />