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Scun6k n e , b-kjobour-ot -70 <br /> ,, .a" x ' y NATURE OF FILING(deck all that appiles) `,.{ >.�` , `- . <br /> ❑CbaU i 1urest Change ownership ane...""'r bion: <br /> ❑ ❑u ,.,e n ana__Ty status sl Trip permit El.reenntetztefl4e.Aerege <br /> ❑.cher <br /> �'� k APRLICANT,IJ FORMATION �.,- <br /> ❑� Dealer/seller ❑Lender ❑Escrow/title agent ❑Owner/buyer ❑Legal representative <br /> Name:NW HOMEBUYERS.NET • <br /> Address(including city,state,and ZIP):7921 SE KING ROAD,STE.1,MILWAUKIE,OR 97222 <br /> Phone:503-762-1915 FAX:503-762-1923 <br /> Email:DANA NWHB@MSN COM <br /> a}r y HOME INFORMATION(*required} '. _ a <br /> Home ID number(if known): DMV X-plate number(if known): <br /> N, V.0 YY1355cl9. Nt; in/ <br /> Moving in from another state <br /> Has.no home ID or X-plate because: D Coming out of county deed records <br /> ❑Other: ,�..,� <br /> Manufacturer: SKYLINE Mode1:1218-CT Yea`6?•t <br /> -Manufacturer serial:number HUD number <br /> �7-Q\- b2c7 -\ \ <br /> D2-3.7_ <br /> *Number of sections: 2 *Square footage'`""" *Number of bedrooms: 3 *Number of bathrooms: 2 <br /> *Type of roofing: *Type of siding:\Atcordi wD *Heating: Deco-'4 L+ *Cooling: /k1O tJ _ <br /> *Date of sale: (0-41-.2_01t *Sales price: � OtS CO *includes land:❑Yes ❑■ No <br /> DEALERIAIFORMATION(If no dealer,leave blank): <br /> Dealer name: Dealer license number: Dealer address and phone: <br /> NWHOMEBUYERS.NET MSD#173 7921 SE KING RD,STE.1 <br /> MILWAUKIE,OR 97222 <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 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(print): Dealer signature: Date: <br /> NWHOMEBUYERS.NET <br /> P„1 s� i� , r� $.TR,ANSPORTERANFORMATION(if not moving,�leave blank)„ u sr " y n <br /> Transporter name: Transporter address and phone: <br /> 440-2952(7/17/COM) Page 2 <br />