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146I iztn-e <br /> P <br /> 1349979 <br /> NATURE OF FILING(chscit all that applies) <br /> rta en ..9 i ilnirfAl9o er 141 no to <br /> [l4 c 9 d': "r p rto i 'e - .r.„ • /Trip permit n lio st ragi <br /> APPLICANT INFORMATION . <br /> 0 Dealer/seller 0 Lender 0 Escrow/title agent J'Owner/buyer Legal representative <br /> Name:Daniel Lee Beougher and Christi Dawn Beougher <br /> Address(including city,state,and ZIP): 11214'HOLDUP LANE SE STAYTON OR 973.83 <br /> Phone: <",-(13- S/)-/ ; <br /> Email: <br /> HOME INFORMATION(*required) <br /> Home ID number(Vknown): DMV X-plate number(if known): <br /> NF% m35841Ca <br /> 0 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 Model:' Year:2019 <br /> Manufacturer serial number HUD number • <br /> ALB038913ORAB <br /> *Number of sections: 2 *Square footagea260 *Numberof bedrooms: Y *Number of bathrooms:2 <br /> *Type of roofing;/ ( (-- *Type of sidingiy' J- y;,,-,n.d d *Heating:dec.)-?t C *Cooling: ,j/ -- <br /> i <br /> *Date of sale: j) *Sales price;`)7a, *includes land: Yeslr'No <br /> • . DEALER INFORMATION of no dealer,leave blank) <br /> Dealer name: _ Dealer 1 tdku# f D 19 5Dealer address and phone: <br /> CLAYTON HOMES ALBANY,OR • CCB #166990 , 1437 CENTURY DRIVE NE <br /> ALBANY OR 91321 <br /> (541)967-8555 <br /> 0 This manufactured structure is free and clear of all mortgages,deeds-9f 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 /> ( ?& uJOr\ )�lorn,CS �;)t+=n�i' �;�.�`(C )'� -\cu!bex- Os) <br /> TRANSPORTER INFORMATION(if not moving, leave blank) <br /> Transporter name: II Transporter address and phone: <br /> . <br /> .(:),UV . rjrr; �` <br /> )D` l -W1 i a?C C,c i b ()12 c,-1.272/ <br /> • <br /> 440x2932(7/17/COM) <br /> OR Title Application-10/2018-TitleApp11211 Page•2 004186486-00001 <br />