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<br /> 1272788
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<br /> ' Q,Recc�li�operty tatus 'rip permit [] er4ed-to-sturage
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<br /> it D Dealer/seller il Lender 0 Escrow/title agent .\Owner/buyer ElLegal representative
<br /> Name:Lindsay Gamer and Brandon Gamer nn
<br /> M Address(including city,state,and ZIP):7 3 ._ c--tt pc. A)6 5alei,, D iZ '1 1305
<br /> p�� Phone: 1110 - Z Z Z- I eze
<br /> A.A Email:
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<br /> al Home ID number(if known): DMV X-NENAJplate number(if known):
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<br /> viti 11 Moving in from another state
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<br /> Has no home ID or X-plate because:
<br /> 0 Coming out of county deed records
<br /> 4 El Other:
<br /> £# Manufacturer:FLEETWOOD Model: Year:2018
<br /> 41
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<br /> FLE230ID 18-334 14A
<br /> *Number of sections: *Square footage: Z fj *Number of bedrooms: 2 *Number of bathrooms:
<br /> t *Type of roofing: 51-traa j, *Type of siding: (ago( r;e *Heating: E ;C *Cooling:
<br /> • *Date of sale: 3/(o / (�3 *Sales price: /19 i I k *Includes land: 0 Yes- No ,
<br /> S <.. `.In . A OPA ERANVQ4 MA71E3 1 f:611.eaiet':teiiii iiiii -..y-M ' ; . _.. ,
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<br /> Dealer name: Dealer license number: Dealer address and phone:
<br /> CLAYTON HOMES ALBANY,OR DLR #MSD195 1437 CENTURY DRIVE NE
<br /> il CCB #166990
<br /> ALBANY OR 97321
<br /> (541)967-8555
<br /> El 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 I understand it
<br /> is made for use as evidence in court and is subject to penalty for perjury.
<br /> Dealer name(print): Dealer signature: Date:
<br /> 0116)-000� A� f ars, tt
<br /> 4 , . \.. ., KAN PORTER 1NFQ lyl/4 104"0fiitXl1: ►R1'.ieaYe Manic}a .-u"_ }„ Z. XM"`N'
<br /> Transporter name: Transporter address and phone:
<br /> 001/I - 51-11 -291 — SIN/
<br /> k6. 440-2952(7/17/COM)
<br /> F OR Title Application-1212017-TitleApp11211 Page 2 004021600-00002
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