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608583
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Last modified
1/19/2024 11:00:49 PM
Creation date
1/19/2024 2:21:33 PM
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Assessor
Account Number
608583
Assessor Doc Type
Trip 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 HOME <br /> • <br /> • FIRST ASSIGNMENT <br /> MANUFACTURER:Fleetwood Homes .For Value Received,the undersigned hereby transfers this Statement of Origin and the manufactured <br /> home described therein to: <br /> ADDRESS: 2655 Progress Way,Woodbum,OR 97071 . Address: <br /> . and certifies that the home is new.and has not been registered in this or any other state;he also warrants <br /> Street,City,State,and Zip the title of said home at time of delivery,subject to the liens and encumbrances,if any,as set out below <br /> . Amt.Of Lien Date To Whom Due Address <br /> The undersigned MANUFACTURER hereby certifies that the new manufactured home described below, Dated , at <br /> the property of said MANUFACTURER,has been transferred By: <br /> this 20th day of April 2023 on Invoice No 202372167500 Transferor(Firm Name) Sign Here Position <br /> —- Dealer 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 /> Distributor,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 Seal <br /> SECOND ASSIGNMENT <br /> Street <br /> For Value Received,the undersigned hereby transfers this Statement of Origin and the manufactured <br /> COSTA MESA, CA 92626 home described therein to: <br /> _ <br /> City,State,and Zip Address: <br /> and certifies that the home is new and has not been registered in this or any other state;he also warrants <br /> Trade Name: 210SP-Sandpointe-14522A Model Year. 2023 the title of said home at time of delivery,subject to the liens and encumbrances,if any,as set out below <br /> Amt.Of Lien Date To Whom Due Address <br /> Model No: 210SP14522A Body Width Ft: 13'8" _ <br /> Body Length Ft: 56'0" /Ft: 52'0" Dated _ , at <br /> Including Hitch Excluding Hitch By: <br /> Transferor(Firm Name) Sign Here Position <br /> Square Feet: 710 Date of Manufacture: 04/10/2023 Dealer License(Permit)No. <br /> Before me personally 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: FLE2100R23-23224A Weight: 20,460 Subscribed and sworn to before me this day of , <br /> Manufacturer's ID No: Weight: Notary Public for County,State of <br /> Manufacturer's ID No: Weight: _ Norm),Seal <br /> THIRD ASSIGNMENT <br /> Manufacturer's ID No: Weight: 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 Lien Date To Whom Due Address ' <br /> ordinary trade and commerce. <br /> ,Fleetwood Homes Dated ' at <br /> By: <br /> tporatian Transferor(Firm Name Sign Here _ <br /> f ( ) Position • <br /> Dealer License(Permit)No. <br /> By: 't-f C 4 (` .ti `JN\' <br /> Before me personally appeared who by me being <br /> . Sign Name Title or Position 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 day of <br /> Notary Public for County,State of <br /> Office Address of Signatoty(City&State) <br /> Notary Seal <br />
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