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ID6.5 ULDond buff.) SECTION 1 NATURE OF FILING (check all that apply) ❑ New home to MHODS ❑ Adding or removing a co-owner ❑ Demolition(Date: ) [' Used home sale ❑ Recording as real property ❑ Converted to storage ❑ Security interest change ❑ Removing from real property status Trip Permit ❑ Transfer by inheritance ❑ Other(please note): SECTION 2 APPLICANT INFORMATION(please print) ❑�D'ea11ler/Seller ❑Lender ❑Escrow/Title Agent [r OwnerBuyer ❑Legal Representative (first,middle,last) GV l l 13 MO-1??d 61 C l J Phone 3 g-7/ 6 Z`, Address: I o 21 Sepixy r 1 S Li &A 4 ra S City: 7 f n e State: ZIP: q ?3 9 2 Email: I py-e- te i-F e. cA 4.6 o. CO r✓i SECTION 3 HOME INFOMATION (information in bold is required) Home ID#: 2J5 q gs OR No Home ID: ❑New Home El Out of state home ❑Leaving County Deed Records Manufacturer: f/ I I 07 Model: g YO p, 100-y( Year: / 9q, Serial Number(s) HUD Label Number(s)*Required if new home bg fLMcig/4I' .q15 8M e2i2 2bbq,(7S #of Sections: / Sq.footage: F2 9 Bedrooms: 2 Bathrooms: z Roofmg type: come Ds;4I 0A Siding type: r J -J j Heating type: t i L Cooling type: Date of sale: flfapplicable) 3-21'2 025 Sale price: F-yee Includes land: ❑Yes ZNo SECTION 4 DEALER INFORMATION(leave blank if no dealer) ` - Name: (first,middle,last) License#: Address: City: State: ZIP: Email: Phone: I hereby declare this manufactured structure is free and clear of all mortgages,deeds of trust,security interests,and liens.I have the legal right to sell this manufactured structure or my interest in it. The information listed is true to the best of my knowledge and belief,and I understand it can be used as evidence in court and is subject to a penalty of perjury. Signature: Date: SECTION 5 HOME LOCATION Current Address: 2-?? E U tr>(g,Y 4 S A d S S f aC e-#/J4 5 City: !v( a pi DU- j1 County:?p l/ State: Q( Zip: j'730/ Park Name: (f applicable) M O yl M O U41) Pa OJ c'.. L 1 c. ❑This is a dealer lot or storage facility ❑This home is being moved to a new location Complete the section below New Address: l b (p S S d U-G� �c&. ► S Qk( e f- II- City: [AJo Apo- l County:No,r fp y\ State:V Zip:q7b7 1 Park Name: (f applicable) ❑This is a dealer lot or storage facility Transporter Name: f c C at . t.,y1-I— C on.S/�.yU - 0 Y1 ( o Phone:S 03 g'11 O 021_ Address: j b 21-c `iak f ts) S� ��a C0. Citygf U f n e r State: °K ec� b Y1 Email: 0\?I-e2.G1 e Yt y c y(x\' t c , C o wi -/ Page 2