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ke''''":4W'.t,'",:=-1",••:='•• • • • ' %,,4% • . •-• <br /> D Change SCVLJUity-in19rest lig Change ownership O-Derrrtienr-----4ate-ced <br /> ItecradiRg-asseaLpzagert4.... <br /> £ -- •• . -. - ; IXTrip permit laecutterted-tersttrage <br /> O lather' <br /> se.-Troo Lender Escrow/title agent FJ.(3wrre :6 )- O.Legal representative <br /> Name: 10-‘64,L£ c_519 k.5 6 Tr <br /> Address(including city,state,and ZIP): PTA (No y 4 4r "7" 7 3 <br /> Phone: ,03- 72 V-.2 7 0 <br /> Email: —ie. ,513,-4AR5.6 TT C 1114/4 C "7 <br /> HOME ik bEitiiktib <br /> Home ID number(if known): DMV X-plate number(if known): <br /> at 62,C L,t-i ry.-)-341 ctql <br /> D Moving in from another state <br /> Has no home ID or X-plate because: [] Coming out of county deed records <br /> 0 Other: <br /> Manufacturer:12\pix,- .\_ey.,., \ cygp cQ1 4kg."" Year:"a001 <br /> Manufacturer serial number HUD number <br /> SiPr ) . -- 00 CVL <br /> cLe, SoD5 . <br /> *Number of sections: eg *Square footage:4056, *iqumber of bedrooms: 2 *Number of bathrooms: <br /> ..2)iterLigg5 <br /> *Type of roofing-.6mtV,.5-read*Type of siding: eth9g,t, I *Heating:Eiee,rg./6, *c ooling:Acr,Axpri <br /> *Date of sale: _Op)/ *Sales price: 1.2t., 16 ..cdo.do *Includes land:D Yes KNo <br /> kE-ACE*141140Cikii01014 (it..; <br /> Dealer name: Dealer license nut -r: Dealer address and phone: <br /> This manufactured structure is free and cle; o mortgages,deeds of trust,security interests,and liens.I have the <br /> legal right to sell this manufactured struct e. <br /> I hereby declare that the above statem t is true to the best o knowledge and belief,and that I understand it is <br /> made for use as evidence in courtzs is subject to penalty for pen iv <br /> Dealer name(pr(nt): Dearer signature: Date: <br /> , . -. - : ,• • • <br /> TRANSPORTER INFORMATION (if not moving, leave.blank) <br /> Transporter name: /dMtU Transporter address and phone: 5'03_ <br /> /ve two/m/-4 / it.&R"ris A . aox K3.2-5-7142., <br /> 7,f41/1 Po R74-716 d J6tte rosy, ne 9 <br /> tjeif.9 3(2. <br /> 443-2052(7/17/C0M) Page 2 • c ENT E fiE <br /> .• <br /> . 7 •R-ft <br /> - - <br />