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ID tU5 3 , ctGi c 1-)k,0 1-1 , Woodbu n <br /> SECTION 1;. NATURE OF FILING (chef that apply) <br /> 0 New home to MHODS L er 1i,i to ' 'o ate: ) <br /> 1Z• Used home sale rty nv d tsttrsage. • <br /> ai.SSkirityihter 0 Trip Permit <br /> 111/l iclesRelOe1Xance tl r n to : <br /> SECTION 2 APPLICANT INFORMATION (please print) ` <br /> ❑Dealer/Seller ❑Lender ❑Escrow/Title Agent ❑� Owner/Buyer ❑Legal Representative <br /> Name: Eulalio Manzo-Garcia Phone:.503-871-0027 <br /> (first,middle, last) <br /> Address: 10275 Parrish Gap Road SE <br /> City: Turner State: OR ZIP: 97392 <br /> • Email: <br /> SECTION 3 HOME INFORMATION.(information in bold is required) <br /> ORNo Home ID: New Home Out of state home gCounty Deed Records <br /> Home ID#: N/A ❑ ❑ ❑Leaving ty <br /> Manufacturer: SUPREME <br /> Model: 70/14 Year: 1984 <br /> Serial Number(s) HUD Label Number(s) *Required if new home <br /> • A7SC23040R • <br /> • <br /> "#of Sections: 1 Sq.footage: 980 Bedrooms: 2 Bathrooms: 2 <br /> Roofing type: Comp Siding type: T1-11 Heating type: Heat pump Cooling type: Heat pump <br /> Date of sale: 10-18-24 rice:'Sale <br /> . afapplicable) P ' $5,000 Includes land: Ill Yes 0 No <br /> SECTION'4 - DEALER INFORMATION (leave blank,if no dealer) •. . <br /> Name: <br /> (first,'middle, last) License#: <br /> Address: • • • <br /> City: State: ZIP: • • <br /> ' Email: Phone: <br /> . I hereby declare 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 or my interest in it. The information listed is true to the best of my knowledge and <br /> belief,and I understand it can be used as evidence in court and is subject to a penalty of perjury. <br /> Signature: Date: <br /> SECTION 5.. : HOME.LOCATION <br /> Current Address: 4621 S 42nd Ave <br /> City: Yakima County: Yq Kf ruck State: WA Zip: 98908 <br /> Park Name: (if applicable) ❑This is a dealer lot or storage facility <br /> ❑This home is being moved to a new location Complete the section below <br /> New Address: 1065 S Pacific Highway #17 <br /> City: Woodburn County: Marion State:OR Zip: 97071. . <br /> Park Name: (if applicable) Belle Passi Estates ❑This is a dealer lot or storage facility <br /> Transporter Name: La Preza Ent Construction Co Phone: <br /> Address: 10275 Parrish Gap city: Turner State: OR <br /> Email: <br /> Page 2 <br />