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• 5 5 ( '-)e,- ^ ^ 'R v <br /> --� -�-_- . <br /> NATURE <br /> ^ ^ <br /> OFFIL[NG (check all that ap {ieg) <br /> .APPLICANT INFORMATION. . <br /> F� Dealer/seller Lender <br /> Legal representative <br /> Numc�AmbarHomesLLC� --------- <br /> Address i and ZIP):201Court, Los Altos, CA 94024 -- <br /> Phonc:253-221'1757 -- <br /> |------------ ----'--� -------' ------------------------ ---� <br /> / [moi|:�are�umbmhomesLLC��gmaiicnm ----- <br /> HOME INFORMATION (* required). ' ' <br /> Home |Dnumber(h/��om�' ��--- Vnumber � <br /> ' , DM X-plate uum r(if6nnvn): <br /> N) irn N.)8 IA) <br /> ri Moving in from another state <br /> Has no home |D or X-plate because: 1 Coming out of county deed records ---------' <br /> � -----� <br /> | | <br /> [I Other:being produced at the factory <br /> Manufacturer:Skyline | K4ode|:VVeotridgo1218CT | Year:2018 <br /> / <br /> Manufacturer serial number | <br /> HUD number <br /> -- --- <br /> BZ'91-0217'L,O • <br /> |- - ------�—' ---�--�-----'-' -- —' — --�-' ---' -------'------------------- <br /> BZ-91'0217'L`A <br /> *Number of sections:2 *Square footage:1419 *Number of bedrooms:3 *Number of bathrooms:2 <br /> *Type of roofing:shingles *Type of siding:hardiboard *Heatinu•electric <br /> 0. *Coolino• <br /> *Date of sale:, *Sales.price: *Includes land: El Yes [I No <br /> DEALER INFORMATION (if no dealer, leave blank) <br /> Dealer name: Dealer license number: Dealer address and phone: <br /> Amber Homes LLC MSD621 201 Silvia Court <br /> • <br /> Los Altos, CA 94024 <br /> 253`221'1757 <br /> _-_-_--______'-�__-_-_--_-__--__—_---'___--__-__- <br /> DIThis manufactured sfmouo is free arid 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 is <br /> made for use as evidence in court and is subject to penalty for perjury. <br /> Dealer name(y,iny: -�-------------' --r�-------'--' -----------'---- Date: ------�---� <br /> Clare Brown 8-24-18 <br /> TRANSPORTER INFORMATION (if not moving, leave b|anKd <br /> _ _____ '_____ --_-_- <br /> Transporter name: [Transporter address and phone: <br /> Blue Haul ! 1690 Harvey St SE, Jefferson, OR 97352 <br /> 971'218'3508 <br /> __'-___-_--__----� ____ <br /> + s � <br /> x� � m � <br /> /� oM` Pooc2 � <br />^ - <br />