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<br /> [t- Plealer%seller'• �'
<br /> Lender . ❑Escrow/title agent ❑ Owner/buyer y El Legal representative
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<br /> Address(including city,..te,and IP): or
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<br /> Phone: I — -- U.. .7D 411.111111111111111111111
<br /> IMMI
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<br /> Home ID number(fknown): • DMV X-plate number(if known):
<br /> N�1� F1A.1
<br /> ❑Moving in from another state
<br /> Has no home ID orX-plate because; 0 Coming out of county deed records
<br /> . . 0 Other:
<br /> Model: Year:
<br /> Manufacturer serial number HUDnumber
<br /> n tuber
<br /> to D 17 _
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<br /> *Number of sections: ' *Square footage ?.1 *Number of bedrooms: / *Number of bathrooms: /
<br /> *Type of roofing: *Type of siding: , = i *Cooling:
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<br /> *Date of sale- ZD / *Sales price 020 dV *Includes Iand ❑Yes [ 1Go
<br /> TV�Y
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<br /> Dealer LaGf�tG�. � Dealer license number: Dealer address and phone:
<br /> 7�tgautt_xerre7413 (,// in6b z/9 r MS'S Ij��de�
<br /> id,.."(bee4,04. 4e9ivi/
<br /> On-is mantifactu.ed.$t acture is free and clear of all mortgages,deeds of trust,security interests,and liens.I have,the
<br /> legal:right to.sell:thisthànufacturëd structure."
<br /> I hereby declare that the above statement is true to the best of my knowledge and belief,and that I understand it is
<br /> made for use as evidence in court and is subject to penalty for perjury.
<br /> Dealer name(print): Dealer signature- Date:
<br /> tt1+..t().-ra•its a`r r.t.--1.+--�'fL"r°�ri.>tf.�ic.4.�*�^�k'ai:.»,<�t�t�r;�J�'$tt:�rai�thYt�Jv�[rxCn5..,tmofn ,-# s i r F i�•lN.,.`�J,-tC,lc�,„,t+.—`.'�.'.y,6r��n,°„ro;'7,'t4�`"1fXptaest d�.Fi.�..idir`^4.fl`o<i3�hy 2 ,lsr1r�.�pRmhc9�ymi y r 0 a.�.t
<br /> �4.uir 4 }i< .,„ c 9 :4
<br /> Transporter name: j) Transporter address and phone:
<br /> . , ifZ 91--1S2-
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<br /> 440-2952(7/17/COM) Page 2
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