Laserfiche WebLink
-7 7 -7 -1-ctLja-k) sE, s u ; / <br /> 1353699 <br /> NATURE OF FILING(check alt that apptles) <br /> s c 'ty ,ter-.t A .t t,- ,� i o 't`.n tate ..'de 1ti. <br /> . t .: _ '4 • i •a , ..f s, , Li Trip permit <br /> Nr: <br /> APPLICANT INFORNJATION <br /> 0 Dealer/seller []Lender Q Escrow/title agent I Q Owner/buyer 0 Legal representative <br /> Name:Karen Hagel <br /> Address(including city,state,and ZIP): 9777 STAYTON RD SE AUMSVILLE OR 97325 <br /> Phone: <br /> Email: <br /> HOME INFORMATION (*required) <br /> Home ID number(if known): DMV X-plate number(if known): <br /> �! W WWI 353Oa— <br /> []Moving in from another state <br /> Has no home ID or X-plate because: <br /> El Coming out of county deed records <br /> 0 Other: <br /> Manufacturer: CLAYTON Model: Year:.2019 <br /> Manufacturer serial number HUD-number <br /> ALB039121ORAB <br /> *Number of sections: Z. *Square footage:Zito *Number of bedrooms: 3 *Number of bathrooms: '2... <br /> *Type of roofing: C *Type of siding: Co, *Heating: F-p-g` *Cooling: FI? <br /> *Date of sale: j p/c/ J 7 *Sales price:isci3s-D, *Includes land: 0 Yes V No <br /> f / DEALER INFORMATION(if no dealer, leave blank) <br /> Dealer name: Dealer license number: 'Dealer address and phone: <br /> CLAYTON HOMES ALBANY,OR 1437 CENTURY DRIVE NE <br /> Yt1 6 I'c ALBANY OR 97321 <br /> (541)967-8555 <br /> E 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 p ty fo a erjury. <br /> Dealer name(print): D:s er signal <br /> Clb <br /> Date: <br /> TRANSPORTER INFORMATION(if 1. moving, lea a blank) <br /> Transporter name: Transporter address and phone: / <br /> 1? u e 11-r,,,Q 3c-Luct 4�..a Y 2.L� SC..-;C) ,O(- 11374. <br /> — 1S"-(:13V- .5s"C) t <br /> 440-2952(7/17/COM) <br /> OR Title Application-10t2018•TitleApp11211 Page 2 004222708-00001 <br />