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‘, k9 G c1,43 Gale,5 9 —1 4 ti2 <br /> SECTION 1 NATURE OF FILING(check all that apply) <br /> ❑ New home to MHODS ❑ Adding or removing a co-owner ❑ Demolition(Date: ) <br /> ❑ Used home sale ❑ Recording as real property 0 Converted to storage <br /> ❑ Security interest change ❑ Removing from real property status I Trip Permit <br /> ❑ Transfer by inheritance ❑ Other(please note): <br /> SECTION 2 •APPLICANT INFORMATION(please print) <br /> RI Dealer/Seller ❑Lender 0 Escrow/Title Agent ❑Owner/Buyer ❑Legal Representative <br /> _(first,middle <br /> N,alas!)me:DoVg s mobile home service inc Phone:503-799-0539 <br /> Address:12692 fry rd ne <br /> city:Aurora State:OR ZIP:97002 <br /> Email:dugwalton@aol.com <br /> SECTION 3 HOME INFORMATION(information In bold is required) <br /> Home ID#: 2.4 OR No Home ID: 0 New Home 0 Out of state home ELeaving County Deed Records <br /> Manufacturer: 60 k- e i L C/a--): <br /> Model: Year: i q 7 q <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> n-06 CAL 4 33 <br /> #of Sections: Sq.footage: f 1,44,e Bedrooms: -3 Bathrooms: ., <br /> Roofing type: C Siding type: Heating type: cil G t-- Cooling type: t p " <br /> Bate of sale: <br /> (tfaPPlicable) 3 ]- Sale price: 17 A, Includes land: ❑Yes No <br /> SECTION 4 DEALER INFORMATION(leave blank if no dealer) <br /> Nat'l Walton License#:11�SD 652 <br /> (first,middle,last) 9 <br /> Address:12692 Fry rd ne <br /> City:Aurora State:OR Z1P:97002 <br /> Email:dugwalton@aol.com Phone:503-799-0539 <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'and be used as evidence in court and is subject to a penalty of perjury. <br /> Signature: / C � Date: 3..2- <br /> SECTION 5 HOME LOCATION <br /> Current Address:$ lain( t; 414,RP 36 Li o 5 1 t . 5 ?-7 <br /> City: County: c-Ic • l z_$ State:Die Zip.l7 <br /> Park Name:(if applicable) This �ty <br /> ❑ is a dealer lot or storage facility <br /> 0 This home is being moved to a new location Complete the section below <br /> el New Address: k <br /> City: ,�. County:ma DA) State: Zi <br /> Park Name:(f applicable) ❑This is a dealer lot or storage facility <br /> Transporter Name:Dougs mobile home service inc Phane:503-799-0539 <br /> Address:12692 Fry rd ne city: Aurora State: OR <br /> Email:dugwalton@aoi.com <br /> Page 2 <br />