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� ail -3 5 wry-my.; 1- Sr, Tvhv <br /> 1370817 <br /> NATURE OF FILING(check all that applies) <br /> * . - sec ." ' '.ter-: ' i:.1- • ,ne s.:'. — -to o i. la - : de•..: itio: <br /> or. • ..� <br /> -a .r..e . .i- . ,;. : . -l! :. : IIS`'I'rip permit '� v d storage <br /> ,ROther: <br /> J <br /> APPLICANT INFORMATION <br /> MDealer/seller fl Lender 0 Escrow/title agent 0 Owner/buyer 0 Legal representative <br /> Name: Kenneth Straw:and Janet Straw <br /> Address(including city,state,and ZIP): 12213 SUMMIT LOOP TURNER OR 97392 <br /> Phone: <br /> Email: <br /> HOME INFORMATION (*required) <br /> Home ID number(if known): DMV X-plate number(if known)Ekki : <br /> WV icy 5 <br /> 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: SKYLINE MCMINNVILLE , Model: WEST RIDGE Year:2019 <br /> Manufacturer serial number HUD number <br /> 2F910243LBA <br /> *Number of sections: Q *Square footage:/4(LT::*Number of bedrooms: 2 *Number of bathrooms: �" <br /> *Type of roofing: (r)(7. ..„./ *Type of siding: (0.„.,,,,v a,,,v u L *Heating: n f *Cooling: <br /> *Date of sale: a.,9 _D20 *Sales price: (0-7�c *Includes land: fl Yes o <br /> DEALER INFORMATION (if no dealer, leave blank) <br /> Dealer name: Dealer license number: Dealer address and phone: <br /> CLAYTON HOMES ALBANY,OR DLR #A15 D 195 1437 CENTURY DRIVE NE <br /> ALBANY OR 97322 <br /> CCB #166990 (541)967-8555 <br /> Ft 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 penalty for perjury. <br /> Dg:ler name(pr'r t): Dealer signature: Date: <br /> 111\ 2)20 <br /> TRANSPORTER INFORMA ON (if not moving, leave blank) <br /> Transporter name: Transporter address and phone: 8 I 4E, 434 5s0 <br /> Blut 3' zaq -\\o‘k 2.20 Sao OR C 13i`t <br /> 440-2952(7/19/COM) <br /> OR Title Application-10/2019-TiticAppl 1211 Page 2 004268572-00001 <br />