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5o \ E ►6 .SECTION 1 lyo u NAT,Uj3E OF FILIN ltheck=all,thatapPlyJ > F e <br /> n <br /> :t;:tt,t <br /> e /lig DS aer l�� e o i date:y ) <br /> Used home sale teltailuerrerty U/ceniertodorage <br /> 11/'SaElnrinterestVeatige j status X Trip Permit <br /> a f ce a note): <br /> SECTION 2 . ma c' r APPLICANriNtQRMATION-(please print) <br /> ❑Dealer/Seller ❑Lender ❑■ Escrow/Title Agent ❑Owner/Buyer ❑Legal Representative <br /> Name:Chicago Title Phone:503-973-7448 <br /> (first,middle,last) 9 <br /> Address:471 NW Burnside Rd. <br /> City:Gresham State:OR ZIP:97030 <br /> Email:michelle.cooper <br /> @ ctt.c„o m <br /> SEcttQN 3 x,HOME1:0 MATI N rm a to ninb d requ:rk) < N <br /> 5 <br /> r <br /> Home ID#: N)4 OR No Home ID: ['New Home ❑Out of state home ❑� Leaving County Deed Records <br /> Manufacturer: Skyline L 4 35L 8 <br /> Model:Silvercrest Year:1993 <br /> Serial Number(s) HUD Label Number(s) *Required if new home <br /> 17708120 <br /> #of Sections: 2 Sq.footage: 1568 Bedrooms: 3 Bathrooms: 2 <br /> Roofing type: Comp/Shingle Siding type: T1- 11 Heating type: Foreced air/elec Cooling type: None <br /> Date of sale: <br /> afapplicable) d-d?j Sale price: 38,900.00 Includes land: ❑Yes 0 No <br /> 'a <br /> SE;CTIO 14 „ DEALER NFORMA�TI N cleave blank if no dealer) w�s`t � '; m <br /> Name: <br /> (first,middle,last) 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 /> SEtCC a�, <br /> TION 51 9�a a u L iu a% *,i3H0 1E I,OCATION .;am lT 111K UE kn rdf, <br /> Current Address:14730 S. Gerkman Rd. <br /> City:Oregon City County:Clackamas State:OR Zip:97045 <br /> Park Name: (if applicable) ❑This is a dealer lot or storage facility <br /> ❑■ This home is being moved to a nliew location Complete the section below <br /> New Address:5041 Cumberland Ct. SE#16 <br /> City:Salem county:Marion State:OR zip:97306 <br /> Park Name: (if applicable) Cumberland Mobile Home Park ❑This is a dealer lot or storage facility <br /> Transporter Name:Doug Walton <br /> r! ,� ,k I,� Phone: 503-799-0539 <br /> Address: l a.(0on— '�t"v 1`'C- t 1-e/ City: �(0 VO\- State: ( 1, tl"�D CZ <br /> Email: Q �� &cs I . 0V✓1 <br /> Page 2 <br />