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0114 etb1F Ntdr) d CrZ_ c1733 <br /> SECTION I. 3.: : ,NATURE.gP FILING(check all that ppply) ; <br /> M New home to MHODS n Adding or removing a co-owner Demolition(Date: <br /> Used home sale Recording as real property Converted to storage <br /> LI Security interest change Removing from real property status , Trip Permit <br /> El Transfer by inheritance Other(please note): <br /> SECTION 2 APPLICANT INFORMATION <br /> 111 Dealer/Seller Lender Escrow/Title Agent El Owner/Buyer Legal Representative <br /> Name: <br /> (first,middle, last) —3ex—r Ze\v'‘ c01,\nthx'A Phone:Scss <br /> Address: It 85:). TAce.cs byx .3 cif <br /> CitY:7 -c5 osn State: t, ZIP: 9133. <br /> Email: JeNrx-,- Grikk-f...v., 5 C4) r.t 0A"V'eNcAA e Ow\ <br /> OOMEOFORNIOON.011100a0361001d-i -req9-*05 €6035K6 <br /> Home ID#: , Ncit6 OR No Home New Home Out of state home 111 Leaving County Deed Records <br /> Manufacturer: I.: <br /> Model: I LI 1 b I Year: 9 90 ci <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> 09 g_ - OR.E: 31662(0 <br /> #of Sections: I Sq.footage: it Bedrooms: 'S Bathrooms: ,2 <br /> Roofing type: rs, Siding type: ticiv‘k Heating type: -F_IQ aric Cooling type: <br /> orri 9 <br /> Date of sale: a a <br /> af applicable) 'ill tail Sale price: (1.1 0 0 Includes land: El Yes [A No <br /> SECTION -,; ,,DEALER INFORMATION (leave Oil*it <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 /> SECTION,.5 : HOME LOCATION <br /> Current Address: k Vck1/4A Ave <br /> City: °cepa\ Toor u County:?ck c, State: w IL\ Zip:1/41(8( ct 0 <br /> Park Name: (if applicable) LI This is a dealer lot or storage facility <br /> 111 This home is being moved to a new location Complete the section below <br /> New Address: 9 SR y c 6)0 1), 0 <br /> City: 54-c,,tbs\-.(3,r% County:irittixx., or\ State: CAL. 3 <br /> Park Name: (if applicable) LI This is a dealer lot or storage facility <br /> Transporter Name: SU s 0C Ovele,5 Phone: SW <br /> Address: It t SoLAArl 4_cr.r% CitYlef f-tiS State:(9K <br /> Email: 3e.--tr4Grvs Olru:1118-%ovl thrt‘ <br /> Page 2 <br />