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. , al55 Ro6 `ins Ln 55, 4a,4 5'a /73OP <br /> Docusign Envelope ID:AD23C59C-D1C5-4111-9876-D59F1463025E <br /> SECTION;[',; < _ NATURE OF FILING.(check all tbat,apply).� , . <br /> New home to MHODS r er b (k a : ) <br /> c:14/; eaal6 ENR4onlagleAttla4elity s e <br /> U/NcetiliD/R0611Ssge o rop rm rip Permit <br /> "EszatatlePelhorrafiee tar,6710044: i <br /> SECTION 2 r ', '" ' APPLtC'ANT INFORMATION(please print) <br /> Wexler/Seller ❑Lender ❑Escrow/Title Agent ❑Owner/Buyer 0 Legal Representative <br /> Name �� � Phone:5-5 -7!r I <br /> (first,middle,last) ��1 Ctn L - <br /> ,�i� f e:f o e, <br /> Address: t g-O D(o Sky rpcirlL C - (.._. L4474-e_ oa <br /> City: ,ry;AA__ State: cA LIP: qc9(.4)+Ci <br /> Email: D A O:Akt_O CP4 li ut fic . l c3 rn <br /> SECTION 3 HOME 1\0RMATION(information in bold is required)' -r <br /> Home ID#: OR " No Home ID: Tew Home D Out of state home El Leaving County Deed Records <br /> Manufacturer: � �` io If l - -- <br /> Model: Cr(t1 e_ a it? c ag-s p Year: <br /> SeTfal Number(s) HUD Label Number(s)*Required if new home <br /> FLE 4,910oRL-1-- ayocth ,fl Q?tl04to <br /> FL E a l o vR.L4 - ot-aer(v73 <br /> #of Sections: a Sq.footage: 145(0 Bedrooms: 3 Bathrooms: Q <br /> Roofing type: ► l c Siding type: T—`it Heating type: poomipCooling type: <br /> Date of sale: Sale price: q,p Includes land: ❑Yes yj No <br /> r� j <br /> CTfQPPlicafile) - p�`t `1 <br /> SECTION 4 , " DEALER INFORMATION(leave blank ifno,dealer) <br /> Name: �-1�i <br /> (first,middle,last) d h ar\ 1 , �t A-1-etr't'1/ j1)e. (�P�-t. License#: `� c„I lO <br /> Address: 12-bexe" (y/ peak ('r s Sttii`e_ a(9O 1 <br /> City: f0t•!Lt State: c V7�nn ZIP: olp(01‘-( <br /> Email: C9CAL?O t nice-611 \ 416'L)till c t t.OM Phone:64 _ & S'—7111 <br /> I hereby declare this manufactured structure is fi'and cl 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 understagtiPlostri be used as evidence in court and is subject to a penalty of perjury. <br /> Signature: aimm.vu l.A. /ti, vt,os Date: I.. <br /> —sieus3aaaua�aru.: <br /> SECTION 5 ; ; , ". HOME LOCATION .." <br /> Current Address: cp 155- „::,\,0;`Rs Lan., E^ .2 4 <br /> City: .54'1 e,M County: M.,yti� State: ©a_ Zip: ( co <br /> Park Name: (if applicable) oaks O��o� / "�` ❑This is a dealer lot or storage facility <br /> Fr Orr . El This home is being moved to a new location Complete the section below <br /> egg: a Lo 55 Pro rE ss ' vaY <br /> City m <br /> alp b GI blj�'rv1 County: a,r i O n. State: .O Zip: 7 6 .1 <br /> e) F.I P.e�h'U_,0 0 C4 ` r o Py-)e 6 ❑This is a dealer lot or storage facility <br /> Transporter Name: Phone: <br /> Address: City: I State: <br /> Email: <br /> Page 2 <br />