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Oa\ G\ 'A a\- GL , Silv n <br /> 1384858 <br /> NAATURE.OF FILING (check all that applies); <br /> <'' -.- :ate--s :f - . , sh • - —.�: • •'.n 0:te , ` ,- ,: j •�. . <br /> comg 'p a ov' o ea o s s ► .'• permit o to Kjiter: <br /> APPLICANT INFORMATION <br /> / Dealer/seller 0 Lender 0 Escrow/title agent 0 Owner/buyer 0 Legal representative • <br /> Name:James Lyle Thurman and Barbara Ann Thurman <br /> Address(including city,state,and ZIP): 1 Dia OAK ST SILVERTON OR 97381 <br /> Phone: <br /> Email: <br /> • <br /> HOME INFORMATION (*required) <br /> Home ID number(if known): DMV X-plate number(ifknown): <br /> E ''`� nn 3 Ga 03-7 4o <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:KL9082CT Year:2020 <br /> Manufacturer serial number IHTD number <br /> 245000HA100470AB <br /> • <br /> *Number of sections: 2 *Square footage: goo *Number of bedrooms: a, *Number of bathrooms: / <br /> *Type of roofing:Arc 5� It *Type of siding:-' ;erncv}• *Heating: v *Cooling: <br /> *Date of sale: e- ,'ZOw 1* v <br /> Sales price: /�i0 7(�3 *Includes land: 0 Yes gNo <br /> DEALER INFORMATION (if no dealer, leave blank) <br /> Dealer name: • Dealer • Dealer address and phone: <br /> CLAYTON HOMES ALBANY,OR LIR #MS D 195 1437 CENTURY DRIVE NE <br /> CCB #166990 ALBANY OR 97322 <br /> (541)967-8555 <br /> 0 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 /> Dealer name(p int): Dealer signature: . Date' f <br /> r), <br /> I <br /> 202d <br /> TRANSPORTER INFORMA,TI N (if not moving, leave blank) <br /> Transporter name: Transporter address and phone: $1 e-4 3 H•5 5o I <br /> 6Vim. 1"iUvl Blot Hovl 3ta.09 i-1 -j 2zb SCio ori C/1314-1 <br /> 440-2952(7/19/COM) • <br /> OR Title Application-10/2019-TitleApp11211 Page 2 004311786-00003 <br />