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Docusign Envelope ID:206FA44C-E5F8-43ED-9974-3A170A6C9248 <br /> DocuSlgn Envelope ID:D3A00396-FEA4-40FB-B698-75E6476A1B6F <br /> SECTION 1 NATURE OF FILING (check all that apply) <br /> PikAVeN.i .rerlttS4vl1 ieDS n r ner i --D1bmt51iiiew(15ate: ) • <br /> 0 Used home sale ctat2litrg,aalt;rt`f ep+yrty N!'(sgnte.14eli-te-sterage <br /> i• a e e t tbttrrea scep Ethos 21 Trip Permit <br /> NALati§fertvglAhtiAuce IN..eltuer(tlenve_uole): <br /> • <br /> • <br /> `SECTION 2 .. APPLICANT INFORMATION (please print) <br /> 0 Dealer/Seller ❑Lender ❑Escrow/Title Agent ❑ Owner/Buyer ❑Legal Representative <br /> Name:US .Horticulture Farmland, LLC Phone: <br /> Ursl,middle,Iasi) • . <br /> • .Address:5250 N. Palm Ave Suite 401 <br /> City:Fresno State:CA zIP:93704 <br /> Email: <br /> SECTION 3; HOME INFORMATION (information in bold is required) • - <br /> Home ID#:117222 OR. No Home ID: ❑New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:REDMAN 131 15 <br /> Model:WYNNEWOOD • <br /> Year; I q 8. <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> • 11824809A <br /> • 11824809B • <br /> tint'Sections: 2 Sq,footage: 1680 Bedrooms: 2 Bathrooms: 2 <br /> Roofing type: Composition Siding type: Vinyl Heating type: Heat pump cooling type:- None. <br /> Date of sale: .2/23/2024 Sale price: Atqutrud with pmC�M W ch . Includes land: ❑Yes ©No <br /> (If applicable) • <br /> •.SECTION:4., DEALER INFORMATION (leave blank if no-dealer) - <br /> Name: • • • <br /> Psi,middle, lost). License#: <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:8272 Little Road S <br /> city:Aumsville county:Marion State:OR zip:97325 • <br /> Park Name: (if applicable) ❑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:17610 Harris Lane <br /> city:Jefferson county:Marion State:OR Zip:97352 <br /> Park Name: (if applicable) ❑This is a dealer lot or storage facility <br /> Transporter Name:3-A Constructions, LLC Phone: (971) 2'18-3568 <br /> Address:1690 Harvey Street SE City: Jefferson state: OR <br /> Email:Info©3aconstructionllc.com <br /> Page 2 <br />