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Mar 12 20,01:36p Dougs Mobile Home Service 503-200-1299 p.2 <br /> 9 I s•' 5 P s 4 Ct-ne) R-0) 1`) E 4 14, soleyn <br /> ., <br /> • <br /> . • •-• .._ <br /> - ..'.NAMMf/ler:OP U G ftfrkeeilchil k5'Ei t App. 6e). <br /> Q Change security interest . . <br /> El Change ownership ❑Demolition Date of demolition: i <br /> QQ Recording as real property 0 Removing from real property siatus �Trip pe <br /> Cher. - permit jam' Convened to storage <br /> Q Dealer/seller - <br /> Q Lender ❑Escrow/title agent <br /> 0 Owner/buyer <br /> Name:Dougs Mobiie Hoge ServiOwner/buyerQ Legal representative I <br /> Address (including city,state,and ZJJ):12692 Fry rd Aurora or 97002 <br /> Phone:503-799-0539 <br /> Email:dugwaiton@aol.com <br /> Lorne IL n>? - -- - • k®il,'iE-tNFOR--DRA TION .',ket�plred)-• : . <br /> number(f/azown): <br /> Divi r date number("I-�own); <br /> 0 Moving in from another state <br /> Has no home ID or X-plate because: <br /> Coming out of county deed records <br /> 0 Other: <br /> Manufacturer: r <br /> Model: <br /> �r zfaoner seek?number Year: 7 7 I <br /> 11 <br /> I <br /> i <br /> '=Number of sections: ;"Square footage: z <br /> 4--Type b `Number of bedrooms: a_ <br /> " ype ofroofin�• _ � *Number of bathrooms: l f <br /> g' 1 "Type ofsiding:ti _.70AI . <br /> Date of sale : *Heating: Cl�e7 Cooling: <br /> •. r• _ "`.7-e; 'Sales price: .. <br /> DEALER'66�F®R��A 1!i1(�'Rl � ".Inctudcs thud: 0 Yes ®i`10 <br /> Dealer name: E'a'-rc Gifi9�; leave-blank)" <br /> Dealer license number: <br /> INC 552 Dealer address and phone:; <br /> Dougs Mobile Home Service <br /> ('12692 Fry rd Aurora or 97002 <br /> 503-799-0539 t <br /> al <br /> This manufactured structure is free and clear of all mortgages,deeds of trust,security <br /> legal right to sell this manufactured structure. � T <br /> 'y interests,and liens.T have the <br /> ii hereby declare that the above sate,; e. � <br /> made forby useas na nt 3;, true to the beet of ray i ovvied' a and er <br /> evidence,n court and is subject to peraity for pet -y. <br /> @?H�a� '� !that_ understand3v <br /> Dealer nameme (print): <br /> Doug r a - Dealer si •.7e: <br /> . Date: <br /> Traps arta name: • <br /> ( ving, ,�aa69e .�11�?t�";n i <br /> Dougs Mobile Home Service iNC Trattspoater address and phone: i <br /> 12692 Fry rd Aurora or 97002 i <br /> 1 <br /> 410-2952(7/!7/COM) ' <br /> Page 2 <br />