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608582
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Last modified
1/19/2024 10:05:23 AM
Creation date
1/19/2024 9:57:24 AM
Metadata
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Assessor
Account Number
608582
Assessor Doc Type
Building Permit
Secondary Assessor Doc Type
Jacket
Doc Type Date
1/18/2024
MTL
072W06BA00800
Assessor Section
Manufactured Structures
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MANUFACTURER'S STATEMENT OR CERTIFICATE OF ORIGIN TO.A MANUFACTURED HOIVIE <br /> FIRST ASSIGNMENT <br /> MANUFACTURER:Fleetwood Homea For Value Received,the undersigned hereby transfers this Statement of Origin and the manufactured <br /> home described therein to: <br /> ADOR . e-r��; a , odburn,,OR 97071 Address: <br /> and certifies that he home ss new.and bias not been registered inlhis or any other state;he also warrants <br /> meet;City,Snare an 17ip the title of said home at time of delivery subject to the liens and encumbrances;ifs any,as set out <br /> Amt.Of Lien Date To Whoni Due Address <br /> The undersigned,MANUFACTURER hereby certifies that the new manufactured home described below, Dated at <br /> tiro property-of said MANUFACTURER,has been.transferred By: <br /> this 27th 'day of April ,. 2023 -on Invoice No 202372198000 Tinn:heron.(17nn Name) Srgn Hue PositionDealer License(Permit)No. <br /> Before me personally appeared. who by me being <br /> To: JO:PROPERTY:GROUP LLC duly sworn upon oath says that the statements set forth above are true and correct. <br /> DrsrriLumr,Dealer;Etc. Subscribed and sworn to before me this day of <br /> Notary Public for County,State of . <br /> Whose Address is: 1700 ADAMS AVENUE SUITE 212 Notary Seel <br /> SECOND ASSIGNMENT <br /> Street For Value Received,the undersigued hereby'transfers this'Statement of Origin and the manufactured <br /> COSTA MESA,CA 92626 home described therein to: <br /> City,Stale,and Zip Address: <br /> nit certifies that the home is new and has not been,registered in this or any other state;he also,warriints <br /> Trade Name: 210SP-Sandpointe-14441 A Model Y " "\' c' e title of said home at time of delivery,subject to the liens and encumbrances,if any,as set out below <br /> a� 4,- __ ''�` Arnt.OfLien Date ToWhonrDue Address <br /> Model No: 210SP14,141A Body.Width Ft •. :1' `Ili <br /> Body Length Ft: ' 48'0" /Ft: 44'0" Dated , at <br /> Including Hitch E•xcludingHitch By: <br /> Transferor(Fran Name) Sign Here Position <br /> Square Feet: 601 Date of Manufacture: 04/24/2023 Dealer License(Permit)No. <br /> Before me pertonally'appeared who by me being <br /> • duly sworn upon oath says that the statements set forth above are true and correct <br /> Manufacturer's ID No:. FLE2100R23-23251A Weight: 18.540 Subscribed..andswont.to before me this day of <br /> 'Manufacturer's ID No: Weight: Notary Public for County,State of <br /> Manufacturer's 1D No: Weight: Notary Seal <br /> Manufacturer's:ID No: Weight: <br /> THIRD ASSIGNMENT. <br /> For Value Received;the undersigned_Hereby transfers this Statement of Origin and the manufactured <br /> Manufacturer's ID No: Weight home described therein to: <br /> Manufacturer's ID No: Weight: Address: . <br /> and certifies that the home is'new and has not been registered in this or any other state;he also warrants <br /> the title of said home at time of delivery,subject to the liens and encumbrances;if any,as set out below <br /> The CORPORATION further Certifies-that this was the first transfer of such new manufactured home in Amt.Of Lieu Date To,Whom Due Address <br /> ordinary trade and commerce. <br /> \ , '\ 9 <br /> Fleetwood Homes Dated ai ,( s� <br /> Corporation BY 1 _ rll 6" II��l�3� . <br /> Tinncfervn(FinuNatrre) e P..2 Position <br /> By. c <br /> ')`,A.IN__ ^ „.. Dealer License(Permit)No.Before mepersonally.appeared who by me being <br /> ' Sign Name Title o ositiarr duly sworn upon'oath,says that the statements set forth above are true and correct. <br /> 2655 Progress Way,Woodbum,OR.97071 Subscribed and sworn.to:before me this rlayof <br /> Notary Public for County,State of <br /> OfceAddress ofSfgiatoty(Citp&State) Notary Seal <br />
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