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• <br /> W . tea; `,r tve_ <br /> 1519917 ` <br /> .; NATURE OF FILING(check all that applies) <br /> UeaV,g'k‘,uft'tcjtitgrCrkt.131.egangrelpvxaiyklp4oliig_ott.o/AexnOA: <br /> ON re pro o ' o ea pro fl)Latt9 g Trip permit Eft n torage <br /> APPLICANT INFORMATION <br /> 0 Dealer/seller Lender Escrow/title agent 0 Owner/buyer 0 Legal representative <br /> Name:Michelle Linhart <br /> Address(including city,state,and ZIP): 637 W.MAIN ST.SILVERTON OR 97381 <br /> Phone: <br /> Email: . <br /> ... �'s ' HOME INFORMATION (*required). . <br /> Home ID number(if known): DMV X-plate number(if known): <br /> 1`➢ E W .. fpp-a'CO l <br /> Moving in from another state <br /> Has no home ID or X-plate because: ❑Coming out of county deed records <br /> Other: <br /> Manufacturer:CMH ALBANY 972 Model: PREFERRED PLUS Year: 2021 <br /> Manufacturer serial number HUD,number <br /> ALB040412ORAB <br /> *Number of sections:._2 *Square footage:2ilco l*Number of bedrooms: C{ *Number of bathrooms: � ._ <br /> *Type of roofin :Type of siding: t'p s��C. PcV*Heatin : *Cooling:yp g•�rc:�. 5����,ts n' �C�....t,l��lz g' �1�c. . g /V'/A Ic.c., <br /> *Date of sale:.g/6, *Sales price: 14 5,t l 3 8 *Includes land: 0 Yes E No <br /> DEALER INFORMATION.(if no dealer, leave blank) <br /> Dealer name: Dealer license number: Dealer address and phone: <br /> CLAYTON HOMES ALBANY,OR M s ( �s 1437 CENTURY DRIVE NE <br /> 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 per* �r <br /> Dealer name(print): Dealer si : �` Date: <br /> 6164 y Poi. How,es o AI La�, /� p 3 <br /> TRANSPORTER INFOR ATION (If not moving, leave blank) <br /> Transporter name: Trans orter address and phone: l�'y1' s79 d 3yy4 <br /> 13e.Avveb� 1CkLK 1 �c...+51zc,r?.f" ® csmg $°`1(v�4� <br /> CLc.elvlb C ti <br /> 440-2952(7/19/COM) <br /> OR Title Application-10/2019-TitleApp11211 Page 2 004733163-00003 <br />