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• NATURE OF FILING (check all that applies) <br /> 11,4tagazgatityteesegi •Change ownership Li • ti.. .t- _ 'd- oli '.' : - <br /> lr yg TclegkivrIerty o e o s 0 Trip permit I '•vr -; s . a_. <br /> Uckftvr: <br /> A <br /> PPLICANT:INFORMATION:, , - ,,, <br /> ❑Dealer/seller ❑Lender ❑Escrow/title agent L.Owner/buyer ❑ Legal representative <br /> Name: 5d tt: r Part‘a Mor;✓� <br /> Address(including city, state,and ZIP): 0 13 o It `4'a � W oo cl too r O R c1 I O'J / <br /> Phone: 1 -5 o3 /5 1 -3(,4 <br /> Email: <br /> - _ HOME INFORMATION (*required) <br /> Home ID number(if known): DMV X-plate number(if known): <br /> g 519 8 d [ x a_o g-cies IY‘ 131)39 <br /> 0 Moving in from another state <br /> Has no home ID or X-plate because: ❑ Coming out of county deed records <br /> ❑ Other: <br /> Manufacturer: 54[l Ur-,p��T Model: Year:lc'n <br /> Manufacturer serial number HUD number <br /> (� R3b ,f6 xy <br /> *Number of sections: *Square footage: (o® *Number of bedrooms: 3 *Number of bathrooms:a. <br /> *Type of roofing: *Type of siding: ()f- jf *Heating: *Cooling:4IQ.pe{`r a9c1 <br /> *Date of sale: 7-q---..7_0,2_6 *Sales price: 1 b IOU) *Includes land: ❑Yes To <br /> DEALER INFORMATION (if no dealer, leave blank) <br /> Dealer name: Dealer license number: Dealer address and phone: <br /> Dougs Mobile Home Service INC 652 12692 Fry RD NE Aurora OR <br /> 97002 503-799-0539 <br /> El 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): Dea : rn ature: Date: <br /> Doug Walto 7--c/P-0404 <br /> •TRANSPORTER INFORMATION( i not moving, leave,blank) <br /> Transporter name: Transporter address and phone: <br /> Dougs Mobile Home Service INC 12692 Fry RD NE Aurora OR 97002 503-799-0539 <br /> 440-2952(7/19/COM) Page 2 <br />