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C) to 5 3 , t- Wood bui l() <br /> SECTION 7; • : NATURE OF FILING (check I that apply) • •• <br /> New home to MHODS er L/Ltlerh io te: ) <br /> 21 Used home sale rcy nv d t •age. <br /> Ocgaskirityitgef'Oerbitangeo 0 Trip Permit <br /> [K,1`r)-ruf l i ems' ance fl r n to <br /> SECTION 2_ APPLICANT INFORMATION (please print) • <br /> ❑Dealer/Seller ❑Lender ❑Escrow/Title Agent ❑■ Owner/Buyer ❑Legal Representative <br /> Name: • <br /> 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 /> SECTIO.N:;3 HOME INFORMATION (information in.bold is required)•:: , <br /> Home ID#: N/A OR No Home ID: ❑New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer: SUPREME <br /> Model: 70/14 Year: 1984 <br /> Serial Number(s) HUD Label Number(s) *Required if new home <br /> A7SC23040R <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: nA <br /> 0-18-24 Sale price: $5,000 Includes land: ❑Yes El No <br /> of applicable) <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 i,net 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 />