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Eo 5O <br /> 61xnnis- -@, 5 <br /> E 4/-4NATURE OF FILING (check all that applies) <br /> ❑ e ur \, Tug'eNym 'ddfr : <br /> r • _ . s r.73 Trip.permit IcafeweViskotepAe <br /> APPLICANT INFORMATION <br /> I:I Dealer/seller ❑Lender ❑Escrow/title agent ❑ Owner/buyer 0 Legal representative <br /> Name:CASCADE FACTORY HOMES,INC <br /> A,1...� (-.....1 't-.. tc ZIP):e^n �I PACIFIC L11AIY/ 'WOODBURN, R <br /> 1.1u uWSJ(including-city,Jtaw,Wilt L+IA)..J V iI. f nVIlIV t IVV 1 , OR 97071 <br /> Phone:(503)981-5314 <br /> Email:JULIE.CASCADEHOMES@YAHOO.COM <br /> HOME.INFORMATION (* required) <br /> Home ID number(if known): DMV X-plate number(if known): <br /> N-P‘ki M35-7 (0O u\/ <br /> ❑Moving in from another state <br /> Has no home ID or X-plate because: .❑Coming out of county deed records <br /> ❑ Other: <br /> Manufacturer:PALM HARBOR Model:4G28563B Year:2019 <br /> • <br /> Manufacturer 1 number TIT TT�_.-...L.... <br /> MMlanulacl.ulel serial numb a <br /> II V1/llUIIIUCl <br /> PHH3100R18-13150A <br /> PHH3100R18-131508 <br /> *Number of sections:2 *Square footage: 1599 *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:1-15-2019 *Sales price:101,490.10 *Includes land: ❑Yes [1]No <br /> DEALER INFORMATION (if no dealer, leave blank) <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 /> ['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 /> realer name(print): I T7�.wL r signature. I Date: <br /> l signature) <br /> CASCADE FACTORY HOMES, INC �Ce c>2Z 711 <br /> TRANSPORTER INFORMATION (if not movin , ave blank) <br /> Transporter nalne: Transporter address and phone: <br /> NEWMAN'S MOBILE HOME TRANSPORT P 0 BOX 236 <br /> SILVERTON, OR 97381 <br /> 1 503-932-5142 <br /> 1 <br /> 440-2952(7117/COM) Page 2 <br />