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• `4-10D-cc3 Sun f 8 s of.v Rot, Sale, Q vo <br /> NATURE OF FILING'(check all that�appIles) s r2 { <br /> C i.,'g- d' e ' 0 Change ownership <br /> L OF: '_ a,: a . .op- \ ' • .vi ' or -a o o o e••• , •is 0 Trip permit of v t or e <br /> r. <br /> ■❑ Dealer/seller _ ❑Lender ❑Escrow/title agent ❑ Owner/buyer ❑ Legal representative <br /> Name:leisureland homes inc <br /> Address(including city, state, and ZIP):33964 oakville rd sw albany or 97321 <br /> Phone:541-928-1555 <br /> Email:leisurelandhomes@gmail.com <br /> t ,HOME°INFORMATION` *regiared) <br /> Home ID number(if known): DMV X-plate number(if known): <br /> NEvv' m3 5B- - <br /> ❑ Moving in from another state <br /> Has no home ID or X-plate because: ❑ Coming out of county deed records <br /> CI Other New Home <br /> Manufacturer:FLEETWOOD Mode1:28703C Year:2020 <br /> Manufacturer serial number HUD number . . , <br /> FLE2100R2020543A+B ORE551333 <br /> ORE551334 <br /> *Number of sections:2 *Square footage:1866 *Number of bedrooms:4 *Number of bathrooms:2 <br /> *Type of roofing:ARCH *Type ofsiding:CEMENT *Heating:ELECTRIC *Cooling:NONE <br /> *Date of sale:01/06/2020 *Salesprice:98301.00 *Includes land: ❑Yes 0 No <br /> n �h DEALER INFORMATION`(r no dealer, leave blank t r ; <br /> a?�//.-:%�.,. ,.. .,,. ....an... ,-. . .. .a ,:,Xe,S„}._ .. .. :1.+..>3f;.. ..,.,. ,.,,...,., ._...._.,o-x .r 4,.,c..:r_ :> ..., C:<.., s. .. ,•v,,.. :.x .. ..??. 1�1.., ...... <br /> Dealer name: Dealer license number: Dealer address and phone: <br /> LEISURELAND HOMES INC • MSD119 33964 OAKVILLE RD SW <br /> ALBANY OR 97321 <br /> 541-928-1555 <br /> 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 per'ury. <br /> Dealer name (print): '0• .1-,r1"1# a i .f I �I�R� Date: <br /> :Il r ' <br /> LEISURELAND HOMES INC 9/1/20 <br /> r1►� <br /> i , -� sit y a. -. j <br /> � x }�,TRAN$P,ORTER INFORMA ION (if not rnoving, leave=blank) ,x, ti t �� '"1 3 >} <br /> � w <br /> Transporter name: Transporter address and phone: <br /> SAME AS ABOVE SAME AS ABOVE <br /> 440-2952(7/19/COM) Page 2 <br />