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, i <br /> NATURE OF FILING (check all that applies) <br /> El-Mange security interest [f-liaegels p ❑Demolition Date of demolition: <br /> El-Recoritmg as reafrif.Verty status (]Trip.permit <br /> 14 Other:New Home <br /> APPLICANT INFORMATION <br /> - TDealer/selleren er 17 Eaczo !ille gent egal representative <br /> Name:Doug Farnham <br /> Address(includingcity,state,'and ZIP): f 3 �Y /am�.1/ P,-4 /9"el__ • <br /> Phone: .co3-. f .� G <br /> Email: Do t,.� 040 Li i-hd 04-Si co <br /> HOME INFORMATION (*required) <br /> Home ID number(fknown): DMV X-plate number(if known): <br /> New Home <br /> ❑Moving in from another state <br /> Has no home ID or X-plate because: ❑Coming out of county deed records <br /> 0 Other:New Home <br /> Manufacturer.Fleetwood Model:Waverly Crest Year:2018 <br /> Manufacturer serial number HUD number <br /> FLE210OR18-18827A <br /> FLE210OR18-188278 <br /> *Number of sections:2 'Square footage:1280 *Number of bedrooms:3 *Number of bathrooms:2 <br /> *Type of roofing:Composition *Type of siding:T-!t! *Heating.Electric ' *Cooling.None <br /> *Date of sale: *Sales price: *Includes Iand:❑Yes 0 No <br /> DEALER INFORMATION (if no dealer, leave blank) <br /> Dealer name: Dealer license number: Dealer address and phone: <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 mannfartured structure. <br /> I hereby declare that the above statement istrue 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 /> TRANSPORTER INFORMATION (if not moving, leave blank) <br /> `` Transporter name: Transporter address and phone: <br /> e 11144)S i i4 <br /> Tat; �® ti* p. ss 'x . .Z4 0 <br /> . 7,0-/-0i//a/2 yi d <br /> 440-2452(7117/COM) Page 2 <br />