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4-1_ <br /> i, a 2 a � e (son vol Es sc 2-7 <br /> _ 3---ePviS0 n <br /> 1325392 <br /> .° ;., :NATU ,, OF 1L� $G (check alt that ap dies) <br /> ge ANrkq'gv u z ::::.L'::,,.,1=- <br /> lijAgAilgeamKprjanrty VAgivithiMearonsr4erty status rx' <br /> Trip permit �v e o age <br /> Lr: <br /> •x `; APP1JcANT"QFORMATIPN <br /> 0 Dealer/seller 0 Lender 0 Escrow/title agent I Q Owner/buyer 0 Legal representative <br /> Name:Rita N Hartzell and Sherri Tredway <br /> Address(including city,state,and ZIP): 14822 JEFFERSON HIGHWAY 99E SW JEFFERSON OR 97352 <br /> Phone: <br /> Email: <br /> - . . HOME INFORMATION (./.`40.74414,4:-.1;7.1',-. <br /> Home ID number(if known): DMV X-plate number(if known): <br /> N£\J/ m ?) 5-14\L <br /> ri Moving in from another state <br /> Has no home ID or X-plate because: Coming out of county deed records <br /> 0 Other: <br /> Manufacturer: CMH HOMES INC Model: Year:2019 <br /> ,-Manufacturer seriial number <br /> - . - . HUD,-number ; ;. <br /> ALB038571ORAB <br /> *Number of sections: 2_,I*Square footage:lis72.. *Number of bedrooms: 3 *Number of bathrooms: <br /> *Type of roofing: YC{ e of siding:� '1 *Type O(yl*co'pag( *Heating: --1.1(4- Cooling: <br /> *Date of sale:3 1'2 (C1 *Sales price'7 t{/,9 'L/ *Includes land: 0 Yesy No <br /> DEALER: NFORMATION (ist no.dealer, leave blank) <br /> Dealer name: Dealer license number: Dealer address and phone: <br /> CLAYTON HOMES ALBANY,OR 1437 CENTURY DRIVE NE <br /> DLR #1u1SD195 ALBANY OR 97321 <br /> - <br /> ; CCS #166990 (541)967-8555 <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 <br /> is made for use as evidence in court and is subject to penalty for perjury. <br /> Dealer name(grin ): <br /> Dealer signature: rDate:,0.,IaLikelark5-4644 Lkf2Qf . 3 <br /> 1,� 0 <br /> TRANSPO ER<INFORMATI N(ifnot moing,leaeblank) { <br /> Transporter name: Transporter address and phone: <br /> I)..el'e-t' 46016 'Tri ►-Spam' I-1-6 1"-0.cc2.4� nig.2, (G 03)55!- 34 54- <br /> e <br /> (7/17/COM) <br /> OR Title Application-10/2018-TitleAppI 1211 Page 2 004151286-00001 <br />