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SECTION.1;.; NATURE OF FILING (chel that apply) <br /> % New home to MHODS er o o ' 'o e: ) <br /> Used home sale g zc11p 6 rty n6�vfr dC f tt ge <br /> e l u o Apr pe-st tis Trip Permit <br /> NViksl}el once tt n to : <br /> SECTION'2 APPLICANT INFORMATION (please print) <br /> ❑Dealer/Seller ❑Lender ❑Escrow/Title Agent 0 Owner/Buyer ❑Legal Representative <br /> Name' Eulalio Manzo-Garcia Phone:.503-871-0027 <br /> airst, 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 /> 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 /> • <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 Saleprice: <br /> (If applicable) <br /> $5,000 Includes land: ❑Yes 0 No <br /> •SECTION=4 . DEALER INFORMATION (leave blank if no dealer) <br /> Name: License#: <br /> (first,•niiddle, last) <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: ►q WA zip: 98908 <br /> � State: <br /> vnci <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 />