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. f NA�`U`RE`fl`F'F[1�7NO �cher�k�li�t�rat��appires}�' k i . <br /> ❑ :. .,ts ,.r- .... ,•,� ..__. ... t _. .. , rte._"r - <br /> e-see —i rest r�,a , `* <br /> ' . : se- ❑ av a al_p�4 �p . 0 Trip permit ❑ C ge <br /> ❑ eh----.: <br /> k a APP �IGAN l PORN�A ON $ <br /> 1=1 Dealer/seller ❑Lender ❑Escrow/title agent ❑ Owner/buyer ❑Legal representative <br /> Name:LEISURELAND HOMES INC <br /> Address(including city, state,and ZIP):33964 OAKVILLE RD SW ALBANY OR 97321 <br /> Phone:541928-1555 <br /> Email:LEISURELANDHOMES@GMAIL.COM <br /> .t <br /> r ME3 <br /> �O :00,RIVIATlO1 X, required ,� ,K 4� �^_ <br /> Home ID number(if known): DMV X- late number(if known): <br /> N rn3551L3 <br /> ❑Moving in from another state <br /> Has no home ID or X-plate because: ❑ Coming out of county deed.records <br /> ■ Other:NEW HOME <br /> Manufacturer 6hoa,4IIN ash S ufer V4 till Model: Hipp' Year:20 l g <br /> Manufacturer serial number • HUD number <br /> fLiEZ111o,17.1, 73?A ORE 53955'3 <br /> *Number of sections: *Square footage:Co0I *Number of bedrooms: / *Number of bathrooms: / <br /> *Type of roofing:ARCH *Type of siding:CEMENT *Heating:ELECTRIC *Cooling:NONE <br /> *Date of sale: q. 1 g *Sales price: 3 �� *-Includes-land: ❑Yes 0 No. <br /> r <br /> DEALERiJNFORMATbON;(tf no'deale y leave blank) e <br /> Dealer name: Dealer license number: Dealer address and.phone: <br /> LEISURELAND HOMES INC. MSD119 33964 OAKVILLE RD SW <br /> ALBANY OR 97321 <br /> 5419281555 <br /> ❑■ 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. <br /> I hereby declare that the above statement is true to the best of my knowledge and belief,and that T.understand it is <br /> made for use as evidencein court and is subject to penalty for perjury. <br /> Dealer name (print): s.� er si a Date: <br /> LEISURELAND HOMES INC <br /> TRANSPORTER IN OR1VIATION (a riot moving leave bank Y °` <br /> ... .n'-• :i,.:.. -_ 1�:.'. 1..:_•... .::.-{::......,:.^':: n,:...'�. .�.c �_ � '. 1 it 4:-t <br /> Transporter name: Transporter address and phone: <br /> LEISURELAND HOMES INC 33964 OAKVILLE RD SW ALBANY OR 97321 <br /> 5419281555 <br /> 440-2952(7/17/COM) Page 2 <br />