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• . 4 <br /> -it <br /> DocuSIgn Envelope ID:3F08C130-636A-4D26-A8D4-ECE9B1A3ED19 3 a-�5 -7`- I V'� �oo �/vi <br /> SECTION 1. NATURE OF FILING(check all that apply) <br /> Cl hIew hou1to MHODS ❑(I c t oar n vi gisco uner e ji 'on ) <br /> Fa Ujod'riaa se a e5 " or pro nve rage <br /> can eyes&change :e ,o g i o,1.aa, •tus J Trip Permit <br /> 11:1, r i a e • e. , o,): <br /> SECTION 2 APPLICANT INFORMATION (please print) <br /> ,I Dealer/Seller ❑Lender ❑Escrow/Title Agent , ,Owner/Buyer ❑Legal Representative <br /> L�,� <br /> rfrst,middlName:e,last) ( tali c3 D (-om I Phone:al pq(eR-35 <br /> "`f <br /> Address: '?.f j- ,t,l'tCi... . NE <br /> — J <br /> City: 41 1rY!)t.i -- State: ( ' ZIP: 617339- <br /> Email: <br /> SECTION 3; HOME INFORMATION(information in bold is required) <br /> Home ID#: N v . OR No Home ID: KNew Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer: Nail! c iLi I yi n s i'i l_9j i caul 5 D-6 <br /> Model: \NII t'—R d"ic. Year: ' <br /> PR <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> #of Sections: I Sq.footage: 1.3K10 Bedrooms: <br /> I .� ,rD Bathrooms: I <br /> Roofing type: :s !I k Siding type: ' k f LCL` Heating type: ...:0(� Cooling type::. /4 <br /> Date sale: I f <br /> ( of sae) Sale price: ,. I Includes land: ❑Yes fo <br /> SECTION 4 _ DEALER INFORMATION(leave blank if no dealer) <br /> ((1;{IIre <br /> ilirst,middlNamee, last; � --o 10- )Y'11�C. License#: <br /> Address: I LI S ( (, ,��.�-t j q 1 V e . <br /> City f .,(/l'I.{.i State: ,ZIP: Qr '?- <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 uncersigaiqtreitritYbe used as evidence in court and is subject to a penalty of perjury. <br /> Signature: (),"V' Date: 5/1/2024 <br /> UbluHEfEe'tT4Cg4'1.,.,-" <br /> SECTION 5 HOME LOCATION <br /> Current Address: LrJL/,5 P 4L( P v <br /> City: A-(.bi,n(.I County: II f ) 1 Stater, Zip: <br /> Park Name: (if applicable) d <br /> 0 This is a dealer lot or storage facility <br /> ❑This home is being moved to a new location Complete the section below <br /> New Address:f • i 0 a 4.s -S.4" <br /> City: WUnbtlinCounty:fJcri:O\ State: .Q Zip:C T1 I <br /> Park Name:(if applicable) 0 This is a dealer lot or storage facility <br /> Transporter Name: h t Tni lii f t.- Phone: 5`i( -a ,3 j ? / <br /> Address: p.0 ,8.0) . [J"i G co City: C fr J"f Q . State: NI( , <br /> Email: <br /> Page 2 <br />