Laserfiche WebLink
SECTION 1 NATURE OF FILING (check all that ap l ) <br /> K' w i S &/ di Vr a'16r A4-0o rf er \DViollV(Vty: ) <br /> ki034 �Khvi Sty L, • t,,tT ge . . .. - <br /> ur 'n s e e i 1 atus ■❑. Trip Permit <br /> l�'eYb' iiexft ice fe e): <br /> SECTION 2 . APPLICANT INFO MATION (please print) .. <br /> ❑Dealer/Seller ❑Lender ❑Escrow/Title Agent ■❑ Owner/Buyer ❑Legal Representative <br /> Name: Federico Rocha Phone: 503-509-3409 <br /> (first, middle, last)) <br /> Address: 8527 Stayton Rd SE _ . <br /> City: Turner State: OR ZIP: 97392 <br /> EmaiLrochareforestation@gmail.com <br /> SECTION 3 ' ": .. .. . ._, <br /> HOME INFORMATION (information in bold is required)„ <br /> Home ID#: 298007 OR No Home ID: ❑New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer: Palm Harbor 11358 <br /> • <br /> Model: Year: 2003 <br /> Serial Number(s) HUD Label Number(s) *Required if new home . <br /> PH2O6151AB <br /> #of Sections: 2 • Sq.footage: 1400 Bedrooms: 4 Bathrooms: 2" <br /> .. Roofing type: Comp Siding type: Nardi Board Heating type: Heat pump Cooling type: Heat pump <br /> Date of sale: <br /> (If applicable) 6-17-24 Sale price: 36,000 Includes land: ❑Yes No <br /> SECTION 4 DEALER INFORMATION (leave blank if no.dealer) <br /> ... .. Name: <br /> (first, middle, last) License#: <br /> Address: • <br /> City State: ZIP: • <br /> • <br /> Email: . . <br /> Phone: <br /> _ I hereby declarethis 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 /> : Came from: 88241 Thomas Lane <br /> City: Veneta County: Lane . State: OR Zip: 97487 <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 /> : Now. Located at: 8527 Stayton Rd SE <br /> City: Turner County: Marion State: OR • Zip: 97392•• .. <br /> Park Name: (if applicable) 0 This is a dealer lot or storage facility <br /> Transporter Name: A-Action Mobile Home Moving & Demolition LLC Phone: 541-935-1786 <br /> Address: 25716 Wiggins Ln City: Veneta State: 'OR S <br /> Email: <br /> Page 2 <br />