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75- . An - ) L 6- <br /> S \\)07k r\ <br /> 1339266 <br /> NATURE OF FILING(check all that applies) <br /> ❑ tp-est ��a�:f� .e . • ••p III on on: <br /> 1-�,,�t o j I r` r,,,, r °� s ] rip permit j storage <br /> LJN"yuer: <br /> AI#11.1 N-t114FOR 0.10N`„ <br /> ❑Dealer/seller ❑Lender ❑Escrow/title agent JOwner/buyer 1❑Legal representative <br /> Name:Richard Fidler and Marie Fidler <br /> Address(including city,state,and ZIP):7578 MOUNT ANGEL HIGHWAY NE SILVERTON OR 97381 <br /> Phone: 503- .7 79-47 5 f0 <br /> Email: <br /> HOME INPORMATf0N(*required) <br /> Home ID number(if known): w IDMV X-plate number(if known): <br /> (l <br /> 357533- NtW' <br /> ❑Moving in from another state <br /> Has no home ID or X-plate because: ❑Coming out of county deed records <br /> Other: <br /> Manufacturer:CLAYTON 'Model: Year:2019 <br /> Manufacturer serial number HUD number <br /> ALB038736ORAB <br /> *Number of sections: " *Square footage:a�,o *Number of bedrooms: f *Number of bathrooms: <br /> *Type of roofing:A0 SJ fi,c s *Type of siding: <br /> Iv onti,pe( Heating: 676(S *Cooling: yq C <br /> *Date of sale: G+ o *Sales price: 2(y /50),9() *Includes land: E Yes No <br /> DEALER INFORMATION Of no dealer, leave blank) <br /> Dealer name: Dealer license number Dealer address and phone: <br /> CLAYTON HOMES ALBANY,OR DLR #M5D 195 1437 CENTURY DRIVE NE <br /> CCB #166990 ALBANY OR 97321 <br /> (541)967-8555 <br /> C 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(print): 'Dealer signature: Date: <br /> 0,260-ort Norylp,s AVb (01t1 <br /> TRANSPORTER INFORMATI (if not moving, leave blank) <br /> Transporter name: Transporter address and phone: <br /> 13I t -46,u1 36.201 { 8!S- v.34/-65o <br /> 440-2952(7/17/COM) <br /> OR Tile Application-10/2018-TileApp 1121 1 Page 2 <br /> 004186045-00002 <br />