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Co Gln <br /> E 1b37, Visc v Po ,t,� POI <br /> Cl56i3f1,od co-c)a T c55 <br /> kiert0 V) <br /> 7( <br /> 1308365 <br /> NATURE OF1 <br /> FtL1NG(ciaeik all ttat,appkesj <br /> Change security interest []Change ownership Demolition Date of demolition: <br /> Recording as real property fl Removing from real property statusj`—`]Trip permit L Converted to storage <br /> Other:St, <br /> Dealer/seller Lender E]Escrow/title agent .Q Owner/buyer fl Legal representative <br /> Name:Barbara S Winderbaum estate <br /> Address(including city,state,and ZIP): 1187 VICTOR POINT RD SILVERTO N OR 97381 <br /> Phone: '5 0.3_T3 D_7$ 1 <br /> Email: <br /> HOME INFORMATION(*required) <br /> Home ID number(if known): DMV X-plate number(if known): <br /> Nod I'Yl 35 G2405 <br /> El Moving in from another state <br /> Has no home ID or X-plate because: ❑Corning out of county deed records <br /> Other: <br /> Manufacturer: CLAYTON (Model: Year:2019 <br /> Manufacturer seritalnumber <br /> ALB038292ORAB " <br /> *Number of sections: *Square footage: t7ZZ *Number of bedrooms: 3 *Number of bathrooms: <br /> *Type of roofing: ,,,,,,f *Type of siding: C.ovN,v *Heating: F A-( *Cooling: 1 Qcd- <br /> *Date of sale: 3 1 7.p. 14 *Sales price 177 147 g *Includes land: Yes IX1 No <br /> DEALER;INFORMATION° (if.no`dealer, leave blanky ; <br /> Dealer name: Dealer license number: Dealer address and phone: <br /> CLAYTON HOMES ALBANY,OR 1437 CENTURY DRIVE NE <br /> Mi Ot 5- ALBANY OR 97321 <br /> (541)967-8555 <br /> r�4 This manufactured structure is free and clear of all mortgagest 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 <br /> is made for use as evidence in court and is subject to penalty for perjury. <br /> Dealer name(print): DEQ alA+l7,N Dea eriignatu • Date: <br /> C.N41511.4G s INS ►-bmes A►`,�` -- 3 ao),q <br /> TRANSPORTER,I NFORMATI <br /> (if'not movtn` eave,;Ilank): ^ = <br /> Transporter name: Transporter address and phone: gig- 3+SS0 j <br /> 3$Z49 Z cc/0 O2 97171- <br /> 440-2952(7/17/COM) <br /> OR Title Application-10/2018 TitleAppl 1211 Page 2 004107394-00002 <br />