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1 / 5U,r111 n Ln A-k.kire) <br /> NATURE:OF FILING.(check 811 that applies.). ..; <br /> ❑C-44031gcsecttretrifiterest ❑Change-ewfiership n n: <br /> rty, [] uovir .€r real pr "'a"'''status 0 Trip permit 0,Getweft8d-to storage <br /> ❑fir: <br /> APPLICANT INFORMATION <br /> Dealer/seller El Lender ❑Escrow/title agent El Owner/buyer [] Legal representative <br /> Name:CASCADE FACTORY HOMES, INC <br /> Address(including city,state,and ZIP):590 N. PACIFIC HWY,WOODBURN,OR 97071 <br /> Phone:(503)981-5314 <br /> Email:CASCADEHOMES@YAHOO.COM <br /> ;.. . HOME.INFORMATION(`:.required} <br /> Home ID number(if known): DMV X-plate number(if/own): <br /> lIEw On 3559 <br /> El Moving in from another state <br /> Has no home ID or X-plate because: ❑Coming out of county deed records <br /> ❑Other: <br /> Manufacturer:FLEETWOOD Model:EAGLE 28483S Year:2018 <br /> Manufacturer serial number • HUD number <br /> FLE2100R18-18917A ORE 540609 <br /> FLE2100R18-18917B ORE 540610 <br /> *Number of sections:2 *Square footage: 1279 *Number of bedrooms:3 *Number of bathrooms:2 <br /> *Type of roofing:COMPOSITIO *Type of siding:CEMENT *Heating:ELECTRIC *Cooling:NO <br /> *Date of sale: *Sales price:55,774.00 *Includes land: ❑Yes 0 N <br /> :DEALER INFORMATION (Ifno_deater,-leave'bJ <br /> Dealer name: Dealer license number: Dealer address and phone: <br /> CASCADE FACTORY HOMES, INC MSD-41 590 N. PACIFIC HWY <br /> WOODBURN, OR 97071 <br /> (503)981-5314 <br /> ❑t 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 (prim): Dealer signature: Date: <br /> CASCADE FACTORY HOMES, INC <br /> TRANSPORTER INFORMATION:(if not moving; leave blank] <br /> Transporter name: Transporter address and phone; <br /> REMOTE MOBILE, LLC P 0 BOX 3028 <br /> BELLINGHAM,WA 98227 <br /> 360-305-6343 <br /> 440-2952(7117/COM) Page 2 <br />