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• <br /> 1257865 <br /> NATURE OF FILING(check all that applies) <br /> D -_ . -. . . .ueyes - ...:- i • --•:'. f±13011113110lion: <br /> .e t..1 e •s•a _ C -..* ..g,• m_reaLpropezty4tatusr / rip permit - e e h ts-stt. ge <br /> L Qther: <br /> APPLICANT INFORM TION - <br /> Deale> sel1er-----E Lender -�Escrow/title-agent I Owner/buyer D.begakepresentativa— <br /> Name:George Hudson and Stacey Wichael <br /> Address(including city,state,and ZIP): /0-3 3 / i 2b <br /> Phone: S'763 6 c Z •-! E-/0 1 ' <br /> / <br /> Email: c.-7L <-c.- e---I(7: y-/di'-'1'2 i-f.,1" 17'1 C 0-\'''`f--t-----1,,-cAfk <br /> HOME INFOFfMATION'*required) _ _ <br /> Home ID number(if known): DMV X-plate number(ifknown): <br /> iQ M,. 3.-ti-7W _ <br /> 0 Moving in from another state R 3C I C.0 <br /> Has no home ID or X-plate because: ❑Coming out of county deed records <br /> D Other: <br /> Manufacturer:CMH ALBANY 972 Model: Year:2018 <br /> Manufacturer serial number HUD number <br /> ALB0375140RAB <br /> *Number of sections: .2._ *Square footage:c2o *Number of bedrooms: Li *Number of bathrooms: 2._ <br /> *Type of roofing: oa-vip *Type of siding: f, 49 *Heating: r,44„--,,,,,,,- *Cooling-9pi <br /> *Date of sale: Si' s-/r *Sales price: vs-7 6g,,6 5 *Includes land: g Yes Q No <br /> DEALER INFORMTION(if no dealer,leave blank) . <br /> Dealer name: Dealer lico; untie,,........= .. — Dealer address and phone: <br /> CLAYTON HOMES ALBANY,OR ' DLR #MSD195 1437 CENTURY DRIVE NE <br /> CCB #1669.90 ALBANY OR 97321 <br /> '- (541)967-8555 <br /> O 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 /> 1 \ VtC)..4c ac •c l ,V i1Y 1 vl�tn(,^C._..T\ i(lam-( ��1 ��{ <br /> TRANSPORTER.INFORMAY .N;(ifnot moving,:leave blank) . <br /> Transporter name: Transporter address and phone: <br /> S-Yl-,j,- - `L/41 <br /> 440-2952(7/17/COM) <br /> OR Title Application-12/2017-TitleApp11211 Page 2 003971290-00009 <br />