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• <br /> NATURE OF FILING (check_all that applses) _.. _ . <br /> ty ere Ed Change ownership I ESIXtetolitra Da o oli n: <br /> f <br /> rijec rd' a • phi mercy Im vi gm r r etas I ISI/Nciplehsit I & ntuRee763419,..skopag2_,. <br /> vierk7� . <br /> P � <br /> er � "r' p �1 i <br /> APPLICANT INFORMLLi4TlON <br /> 0 Dealer/seller I 0 Lender I 0 Escrow/title agent I ,,II Owner/buyer I 0 Legal representative <br /> Name: A-k9..L.--- J j c f 61 or QT1 <br /> Acdrdregg(including ding rity,state and 9.TP) d g L 9 PUt,),(8-..2 , &\(- Rol RA <br /> Phone: cry-7> x'19:.-C)` l <br /> Email: 3 0 Aci, )011\0". .o \ Ec12''rlGu3l...ed <br /> HOME INFO_ RMATION (* re'qusre4) <br /> Home ID number (if known) . I DMV X-plate number(if known): <br /> ❑Moving in from another state <br /> Has no home ID or X-platc bccausc: 0 Coming out of county deed records <br /> I U Other: <br /> , A� - Year: (. "„ <br /> Manufacturer: I_ _i,� I Model: U:(V — ¶7 0 <br /> Manufacturer seri., number IUD number <br /> . I. <br /> • f4 g•93inDIA-)LI0u L1.9 q A- <br /> I7 ,2,1 3 Dt.7 L) bra 49 9 IS <br /> *Number of gertinng• a, I *Square fnntage•]©( I *Number ofbecdrnnmc• 3 I *Number nfhathrnnmg• 1,5— <br /> j / <br /> *Type of roofmg:(_ 9`,,i),ICn *Type of siding:LGI.. 1144:4-4 I *Heating: e4 cfr, I x- <br /> Cooling: irlo/t. <br /> f <br /> *Date of sale: 3 )ig I *Sales price: *Includes land: ❑Yes No 4 I <br /> DEALER INFORMATION (if no dearer, leave bank) , <br /> Dealer name: Dealer license number: Dealer address and phone: <br /> . 1 1: T I <br /> tJ 1111J ll1tl11LLltll%LU1Gl1 tiLLLLI%LLLtG 1J flee2111LL 1:1G[ll Ul 2111 1llU1Lgil.�.'G5, LLLL1� <br /> GGl1J Ul LL�L�,GLL11Ly LLLlG1GJLJ,awli1G11J. 1 ll21VG LLLG <br /> legal right to sell this manufactured structure. <br /> I hereby declare that the above statement is true to the best of my knowledge and belief;and that I understand it is <br /> made for use as evidence in court and is subject to penalty for perjury. <br /> Dealer name (print): I Dealer signature: I Date: <br /> I <br /> TRANSPORTER INFORMATION (if not`moving, leave blak.nk) _ <br /> Transporter name: Transporter address and�phone: <br /> /'77.. SZlvv 1 ill Or <br /> -bc-A �f "'r I -kv`9f \) OK ' 73l 503 3. j-9i'lo <br /> 440-2952(7/17/COM) Page 2 <br />