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606729
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Last modified
6/2/2023 8:59:42 AM
Creation date
3/22/2023 8:03:40 AM
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Assessor
Account Number
606729
Assessor Doc Type
Trip Permit
Doc Type Date
3/21/2023
MTL
072W06BA00800
Assessor Section
Manufactured Structures
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MANUFACTURER'S STATEMENT OR CERTIFICATE OF ORIGIN TO A MANUFACTURED.HOME. <br /> - yIRST ASSIGNMENT: <br /> MANUFACTURER: Fleetwood or Value Received,the undersigned hereby transfers this Statement of Origin and the manufacturFleetwoodHomes,Inc.InC. home described therein to <br /> Address: to this or an artier State;he also warrants <br /> P rest;Way,Woodburn,OR 97071 and certifies that the home is new and has not been registered y <br /> ADDRESS: 2655 m9 ythe liens and encumbrances,if any,as set out below <br /> subject to <br /> of• <br /> home at time <br /> title of said delivery, . <br /> Street.Cay.Boater and Zip • the <br /> Amt.Of Lien Date To Whom Due Address <br /> certifies that the new manufactured home described below, Dyed atThe undersigned MANUFACTURER hereby By:the property of said MANUFACTURER,has been transferred 7 Sign Here Position <br /> hvuferor(km'Name) <br /> • <br /> this 1st day of NoYember 2022 on Itivoice No 202160030200 Dealer license(Permit)No. who by me being <br /> Before me personally appealed • <br /> duly sworn upon oath says that the statements set forth above are true and correct. <br /> To: JO PROPERTY GROUP LL C Subscribed and sworn to before me this day of <br /> Distributor.ate,Etc. Notary public for County,State of <br /> • Notary Seal <br /> Whose Address is: 1700 ADAMS AVENUE SUITE 212 SECOND ASSIGNMENT ; <br /> Super For Value Received,the undersigned hereby transfers this Statement of Origin'and the manufactured <br /> home described therein to: <br /> COSTA MESA CA 92626 City,Stare,cord Up Address:and certifies that the home is new and has not been registered in this or any other state;he also warrants <br /> • <br /> Trade Name: 210SP-SandPte 14522A Model Year: <br /> the title of said home at time of delivery,subject to the liens and encumbrances,if any,as set out below <br /> 2023 Amt.Of Lien Date To Whom Due Address <br /> Model No: 210SP14522A Body Width Ft: 13'8' <br /> • <br /> Body Length Ft: <br /> 56'0° IFt: 52'0' BY: <br /> including Midi Excluding Hitch 71:vuferor arm Name) Sign Herr Position <br /> Square Feet 710 Date of Manufacture: 10/21/2022 Dealer License(Permit)No. who by me being <br /> Before me personally appeared <br /> duly swam upon oath says that the statements set forth above arc true and correct. <br /> Weight: 24,130 Subscribed and sworn to before me this day of . <br /> Manufacturer's LD No: FLE21 OORZZ-22810A Notary Public for County,State of <br /> Manufacturer's ID No: Weight: Notary Seal <br /> { Manufacturer's ID No: Weight. THIRD ASSIGNMENT <br /> Origin and the manufactured <br /> Manufacturer's II)No: Weight For Value Received,the undersigned hereby transfers this Statement of <br /> Weight: home described therein to: <br /> Manufacturer's ID No:i Address:Weight: • <br /> and certifies that the home is new and has not been registered in this or any other stale;he also warrants <br /> Manufacturer's ID No: <br /> the title of said home at time of delivery,subject to the liens and encumbrances,if any,as set out below <br /> The CORPORATION further Certifies that this was the first transfer of such new manufactured home in Amt.Of Lien Date <br /> To Whom Due Address <br /> i ordinary trade and commerce . • <br /> Fleetwood Homes,Inc ts"Here - Peoples <br /> Corporation ,.. .-......- ....,.. 7}muJ�r(Firm Name) <br /> SJ <br /> , / Dealer License(Permit)No. ' <br /> • <br /> ACr t,dtyq-: A 5 I'7F Before me personally apPewed <br /> •By: who by me being <br /> Na ra • TirIC FPasttlaa duly sworn upon oath says that the statements set forth"above are true and carted <br /> Subscribed and sworn t o before me this" day of <br /> 2655 Prdgress Way,Woodburn,OR.9707b • Notary Public for County;State of <br /> Qifice 4fdrry of Srgraror�(Cry d��areJ, ;."Natarp Seal <br />
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