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- NATURE OF.FILING (check all that applies) - <br /> I nc D Change ownership to a tion: <br /> [� oB c <br /> a e rt9je fr al p Trip permit El-eakteptSuastenage <br /> - APPUUCAINTINFORMATION <br /> Dealer/seller I ❑ Lender ❑Escrow/title agent ❑ Owner/buyer ❑ Legal representative <br /> Name:Dougs Mobile Home Service INC <br /> Address(including city,state,and ZIP):12692 Fry rd Aurora or 97002 <br /> Phone:503-799-0539 <br /> Email:dugwaltondaol_com <br /> HOME INFORMATION.r required) <br /> Home ID number(if lalowam): DMV;-plate number(if known): <br /> ❑Moving in from another state <br /> Has no home ID or X-plate because: fl Coming out of county deed records <br /> ❑ Other: j <br /> i <br /> Manufacturer: `� , Model: ! Year: <br /> Manufacturer serial number =BUD number <br /> pp <br /> 1401 et <br /> "Number of sections: '`Square footage: I E s8, *Number of bedrooms: -Nu ber of bathrooms: <br /> `Type of roofing: /,j,, ? '--'_type of siding: 1.4c),,--city 'Heating: I,.7-- `Cooling:� l <br /> *Date of sale: le_ 19 cJ *Sales price: J p,acv f *Includes land: 0 Yes I f No <br /> DEALER INFORMsATION (if no dealer, ieave blank) <br /> Dealer name: Dealer license number: Dealer address and phone: <br /> Dougs Mobile Home Service INC 652 12692 Fry rd Aurora or 97002 <br /> 503-799-0539 <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): I Dealer sin.- e: Date: <br /> Doug Walton <br /> C/-3 —7°9 <br /> TRANSPORTER INFORMATION (i ,ot raving, leave blank) <br /> Transporter name: Transporter address and phone: <br /> Dougs Mobile Home Service INC 12692 Fry rd Aurora or 97002 <br /> 440-2952(7/17/COM) Page 2 <br /> z'd 66Z1-OOZ-£09 eouueg eLUGH ellgovi s6noa d6£:£0'61, CO deS <br />