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Qv, 3'7 1--60- ; apq 311 R rei J <br /> h <br /> NATURE OF FILING (check all tha plies) <br /> a' tepest UI Change ownership ©'Vth t°ten Rakst_citiaut1ir13n: <br /> NMAJAPO.INApicpAty El Removing from real property status ■❑ Trip permit91y, tei t s ra e <br /> APPLICANT INFORMATION <br /> ❑Dealer/seller ❑ Lender ❑ Escrow/title agent ttl Owner/buyer ❑ Legal representative <br /> Name:Philip A Bond <br /> Address(including city, state, and ZIP): PO Box 322, Donald, OR 97020 <br /> Phone: 503-730-8220 <br /> Email: <br /> HOME INFORMATION (*required) <br /> Home ID number(if known): DMV X-plate number(if known): <br /> X217569 YY‘ 1 '3'Z›C-7-. <br /> Moving in from another state <br /> Has no home ID or X-plate because: n Coming out of county deed records <br /> n Other <br /> Manufacturer: Berkshire Model: Year:1992 <br /> Manufacturer serial number HUD number <br /> ORFLN48AB1442OBS <br /> *Number of sections: 2 *Square footage: 1868 *Number of bedrooms:3 *Number of bathrooms: 2 <br /> *Type of roofing:Comp *Type of siding: Lap Cement *Heating: Heat Pump *Cooling: Heat Pump <br /> *Date of sale: q .7_e;_ ci *Sales price: $5,000.00 *Includes land: ❑ Yes 0 No <br /> DEALER INFORMATION (if no dealer, leave blank) <br /> Dealer name: Dealer license number: Dealer address and phone: <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 /> TRANSPORTER INFORMATION (if not moving, leave blank) <br /> Transporter name: Transporter address and phone: <br /> 440-2952(7/19/COM) Page 2 <br />