Laserfiche WebLink
au.14-c )1,tt RCA k)E 4u-rc) r-7- <br /> DocuSign Envelope ID:F22AB349-941C-4DB6-B.` ``'B48E3ADF062 <br /> 1397019 <br /> NATURE OF FILING (check all that applies) <br /> e s ucit�in st' �wn 1p 'i e olition� <br /> R rd' -alp ' ovin: - sin :.. s ro s- :tus ilr rip permit ,e. to rage <br /> Estik: <br /> APPLICANT INFORMATION <br /> 0 Dealer/seller 0 Lender ❑Escrow/title agent ®'Owner/buyer 0 Legal representative <br /> Name:Linda Hammersley <br /> Address(including city,state,and ZIP):22235 BUTTE VILLE RD.NE AURORA OR 97002 <br /> Phone:- <br /> Email: <br /> honeyEmail: LGrntvlarQ y �er� <br /> HOME INFORMATION(*required) <br /> Home ID number(ifknown): DMV X-plate number((known): <br /> 0 Moving in from another state <br /> Has no home ID or X-plate because: <br /> 1-1 Coming out of county deed records <br /> Other: <br /> Manufacturer:CMH ALBANY 972 Model:PREFERRED PLUS Year:2020 <br /> Manufacturer serial number HUD number <br /> AL% OZela4.P,OZA � F <br /> *Number of sections: aZ *Square footage: *Number of bedrooms: <br /> 2Uyb I .3 *Number of bathrooms: ',Z <br /> *Type of roofing:A, _SL;qt*Type of siding: G� P'I.hk *Heating: r(,j,r; (*Cooling: N/A <br /> *Date of sale: 3'/. .5/2e*Sales price: f 'g 477. 40 *Includes land: 0 Yes 2 No <br /> DEALER INFORMATION(if no dealer,leave blank) <br /> Dealer name: Dealer license number: Dealer address and phone: <br /> CLAYTON HOMES ALBANY,OR DLR #MSD195 ( 1437 CENTURY DRIVE NE <br /> CCB #166990 �I ALBANY OR 97322 <br /> (541)967-8555 <br /> Ei 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(print): l Baler signature: Date: <br /> ,. .,.. �i � : LA P to is 207 <br /> TRANSPORTER INFORMATI N(if not moving, leave blank) <br /> Transporter name: Trans orter addre5s and phone: <br /> 440-2952(7/19/COM) <br /> OR Title Application-10/2019-TitleApp11211 Page 2 004324926-00001 <br />