|
4 {V (-1-ha 12.3j
<br /> 1 r t I •Tp' .E '1 �t-.'C,. �R�SSf}:. "N:.'1.1'IHl:L: !p{�'t- v?':�.� �} t: �.'.�.r� �:Ii �;:�"' f�Jy.
<br /> t':r: :('4i�+•' �Y;! �.?��ir?�i"�.tit.t:.i:r�1�.'�� r y ��sq. � .�'` 4p?.'j'Y�gY':tiy"C.. ,�:�,.,�. t,i'�iq:1n`�:''-t.'���"��e��� �'• �t/•a .,�..a-x7: i'.t�4�-�
<br /> TU,RE OAF FILING (^c'heckl th�tPPl�es) �,.:.. � ,•;. ,�,. 1..�
<br /> ..'...✓J�.G.:eh_:•a�,:•K ,..x•.kS_•sti.r..,..�.-�sn^; ¢1. 41.1+04c:•..re.:a3seaa,n.�ra..a ti��'.,t.... az`,Y�✓...Fbii��s_..�'1 ..-.:tf.
<br /> CtittskyWynciyikros
<br /> t f; Change ownership I- o- *on II
<br /> 'I • • t . -a F . e. J s - •. i : 'r. r a .r..- to _ s N Trip permit to torage
<br /> trier:
<br /> - ,,r,� ':e-* �c i ',r::r'. .�i"L'i+r, ✓�f.� .7.e.;�^5,= :ria :it�s'.u�Aeti:;d..sr;•t;�a,Y�"xirii a.- � '�:-' '-�Pyh•s � .:. 'z
<br /> r;� RMATfrgi _�. ��7 �'
<br /> :;,., '» ;� ` .. PrPL�ICANT.�INFO. H , e � '
<br /> ,i•.r. .... ...�! :.ifi2<�n?,:-t�t �sl i.'c,'J�. .:.r':h.tis-.....:!:�:u ._.. .a... ..a_;tia<-ca6..:t.:�G�-4lxtbl.+:�nLk,sa�,'r.�:.+�Ye4Zc:i ti�.+.Y.i•S.+"�1:.h�f�z7i F��,�t l�_�f �ti�t'JZ3?.L'.+Y::t,''S§i.'(i�.:..'�C3�i
<br /> E Dealer/seller ❑ Lender ❑ Escrow/title agent fi Owner/buyer ❑ Legal representative
<br /> Name: 1.\` P t C--\C"C\CksCN
<br /> Address (including city, state, and ZIP):'' (11 � l��C /c1 E.61L,erAdO o 9 o Z3 C 3
<br /> Phone: 92-i _ I c
<br /> Email: M ®
<br /> C \ � CAL
<br /> ge grkgaf'; K®�Fat= yCa�
<br /> rVsTY • � �iq_ " w ,•,F
<br /> y114,4F(41t : _
<br /> Home ID number(if known): DMV X-plate number(if known):
<br /> 2PI0 't6 1U E\i✓
<br /> ❑ Moving in from another state
<br /> Has no home ID or X-plate because: h Coming out of county deed records
<br /> h Other:
<br /> Manufacturer: (1 (.1 , /A Model: C11 n C1 c../A Year: ,8 Z
<br /> Manufacturer serial number HUD number
<br /> 0,0 o'n-W\ •
<br /> •
<br /> •
<br /> *Number of sections: Z *Square footage: / o *Number of bedrooms: *Number of bathrooms: 62
<br /> *Type of roofmg: �lJ *Type of siding: •4 l a .. ( *Heating: \e_c_\1_1:\c *Cooling:
<br /> *Date of sale: Li /03 // *Sales price: 00 *Includes land: ❑ Yes gNo
<br /> ter= ;? r�: -.0t4 o E ALe {IfN '.ORM ► I o ; Vin ea e. uaAn
<br /> Dealer name: Dealer license number: Dealer address and phone:
<br /> •
<br /> �► 11- A) l
<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): Dealer signature: Date:
<br /> •
<br /> r.' - '- 4 -iv•'�� k�' ;4.�.✓:-s _ ;w .•u�^ �r <, - .a•..� .'j..a, .a��J 'Sr` r. `5',ie'q`....s M1•.f ,«p '.�z
<br /> q •`t ' : ` °,+;PV;`,,1,xa. it T. -Sra..Egiti� 2fi41 rr'IS:g fr+�;: t � i + r .. ° ,F tifL'it •,:ti+``_V gi �i i
<br /> �y+ � .�'�.� �.r 4 y f� r {b - ��'. � 4 to a Par a �, /- `.I� kr ...
<br /> '8�` " 'FRANS•P0,RTERtiIN.F.O.RM .N (fif no#rtrn;eutng ]eavet)Iank)' ,j'
<br /> tt!. •�r'ahi`i�=:b`-y.�'atx�''�s'�,�.;. �' �.t,�-;c` F.„ MATO
<br /> �.'�����''.�'i-}._,.to._`^.
<br /> •r�i;'i'-:'v. �4 �}' 7'.. •]'..°�.`-:T:i.. .�:�: rrl?i.._.6,..:. v.. ^...f'i.'ri."i+� �v. � 'fit.
<br /> Transporter name: Transporter address and phone:
<br /> QOM:
<br /> 440-2952(7/17/COM) Page 2
<br />
|