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. <br /> 3� <br /> � - � � � � �- -�� <br /> 4(1 \5 �� �� �� ���� ~-��Z �]Swea ' ~- ° . ��� ~~ � �� �-��'_�~ ~�-=. , . � <br /> NATURE OF FILING (check aUthatapp|iemJ <br /> ettr- <br /> ' APPLICANT INFORMATION ` <br /> Deu|o�scU ��crLender |--' ----- <br /> __-_- --_ �� Escro" t^'eagevtuwncnmuye/ Legal representative <br /> Nume�m��rHumoa LLC • <br /> __ <br /> Address(including city.state, and ZU`):201 Silvia Court, Los Altos, CA <br /> 94024 <br /> -------- ------ ---� - <br /> Phone:253-221-1757 <br /> Emui|:dane.amberhnmeuLLC��gmaU.oum <br /> HOME INFORMATION (* required) . <br /> � <br /> Home |Dnumber(i/kx/wn)' ------- --- � �~ <br /> . number(//k^,v'* ��' ��� w������� <br /> �� E�� ���� � - <br /> , - ^_ -- <br /> | | Movinginfrom000rhersm\c <br /> Has no home ID or X-plate because: fl Coming out of county deed records <br /> 0dccbeingproduced o0the factory <br /> __________ <br /> I Manufacturer:Skyline [ Modcl:Ramada Va|uo 9U17'CT Yoxc2018 <br /> Manufacturer serial number HUD number <br /> — --------- ---------l------'--- - --- --- <br /> BZ'91'0246'L'B <br /> 8Z'91-0246-LA <br /> • <br /> • <br /> *NUmber of <br /> ------_ - F.Square.footage --- [*Number"' """'"""m:" mzo/ nanroons:2 <br /> Type of rooflng:shingles <br /> | *Type n[sid\ng:hanUboard *Coo|inQ: -- <br /> _---_-� <br /> *Date of sale: | *6a|�sprice: f*Includes |and���� Yos ��No <br /> | <br /> DEALER INFORMATION (if no dealer, leave blank) <br /> ________ <br /> Dealer ��----------- --- -- -- -�---'----� ----- <br /> no��� Dealer license nLlmher: / Dealer address and phone: <br /> Amber Homes LLC MSD621 201 Silvia Court <br /> Los Altos, CA 94024 <br /> 253-221-1757 <br /> Thiymuoufocmrcds\mc�uncis6ncandc|caro[o|| mndeeds �� � interests, <br /> --'------��— <br /> == mortgages, c� so trust. i nic,cgs`und 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(pvi/V' ----------] ' '-'-----'-- <br /> (prim): sig Date: <br /> Clare Brown � � <br /> � �� ,�� 9-20-18- ` <br /> TRANSPORTER INFORMATION (if not nnovin�' leave blank) <br /> Transporter name: Transporter address and phone: <br /> Doug's Mobile Home Service Aurora, OR 97002 <br /> 541'730-6101 • <br /> � +02952/7;/7/oOw' Puuc2 <br />