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4-1-\ E S a_.)4_1— <br /> C4 P ,- <br /> St Ta. <br /> NATURE OF FILING (check all that applies) <br /> a s e e 61 VS14 n i i s <br /> DI i i ;re r rty, [I ' i' •v • i i:. r. :i. . Q Trip permit '4• dA% e <br /> ' „eRher: <br /> APPLICANT INFORMATION <br /> Q Dealer/seller ❑ Lender ❑Escrow/title agent ❑ 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:JULIE.CASCADEHOMES@YAHOO.COM <br /> HOME INFORMATION (* required) <br /> Home ID number(if known): DMV X-plate number(if known): <br /> NEW m'35`734 <br /> ❑ Moving in from another state <br /> Has no home ID or X-plate because: ❑Coming out of county deed records <br /> • <br /> ❑ Other: <br /> Manufacturer:SKYLINE HOMES Model:ARLINGTON G560CT Year:2019 <br /> Manufacturer serial number HUD number <br /> 1191-0400-L B ORE 545241 <br /> 1191-0400-L A <br /> ORE 545242 <br /> *Number of sections:2 *Square footage: 1386 *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:65,851.00 *Includes land: ❑Yes 0 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 /> Dealer name (print):nt): Dealer signature: Date: <br /> CASCADE FACTORY HOMES, INC <br /> TRANS PORTER-INFORMATION. if not moving;leave blank)............ ....... ... ... . . . <br /> Transporter name: Transporter address and phone: <br /> SUPERIOR HOME TRANSPORT P 0 BOX 1067 <br /> JEFFERSON, OR 97352 <br /> 541-327-7805 <br /> 440-2952(ii I7,COM) Page 2 <br />