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• <br /> 9Q3 vt SE, S73op„ <br /> 1542679 <br /> SECTION 1 <br /> NATURE.OF FILING(check all that',apply). <br /> $inV6treitu'1g o ewfr o Il. <br /> ).. <br /> rtl>1ketilintft-saie <br /> c4 °• g`P�e1ty �nvts'todMst�rage <br /> e o o tus A Trip Permit <br /> ' b t pce t ote): - <br /> SECTION,2 ' APPLICANT iNFORMATION(please print <br /> n Dealer/Seller r Lender 1-Escrow/Title Agent ( 'Owner/Buyer r Legal Representative <br /> Name: Allan King - <br /> (first,middle,last) Phone:5� <br /> Address: 925 VISTA AVE'SE <br /> ssqz1 epic.), <br /> City: SALEM State: OR <br /> ZIP: 97302 <br /> Email: K;� a((ad e I . c o rn . rv, <br /> `SECTION 3 <br /> 1 � HOME,tNFORNpATI®N(Intormation_In bold Is required} '" <br /> Home ID#: OR No Home ID:C New Home 17 Out of state home fi Leaving County Deed Records <br /> Manufacturer: CMH ALBANY'972 I _il I a*--7 <br /> Model: PREFERRED PLUS Year: 2021 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> ALB040874ORAB <br /> #of Sections: - Sq.footage: l&20 Bedrooms: 3 ' Bathrooms: 2 ._ <br /> ,Roofing type:4.44 :9):041 c; Siding type: Gera.Plwn e. Heating type: EI tL Cooling type: <br /> Date �� - ' <br /> (Ilapplicableofsale:) 1 l/� ��z3 Sale price: t xa I,et 13 Includes Iand: 0 Yes [ 'No <br /> SECTION 4 DEALER INFORMATION(leave blank If no dealer) <br /> Name: CLAYTON HOMES ALBANY,OR <br /> (first,middle,last) 4 LicenseAl#: <br /> Address: 1437 CENTURY DRIVE NE $� I <br /> City: ALBANY State: OR ZIP: 97322 <br /> Email:.Lc 6 f( '0 .64. }-or Li(1 Y►�1 5• �O yv� Phone: (541)967-8555 <br /> I hereby declare this mani'ufacturedjtructure 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:�1(I}. . Al1-9./ =I Date: <br /> :'SECTION 5 I((27�7-?, <br /> Homq LOCATION • <br /> Current Addr ., : Iy 37. C.,�,1,,r), t —. A)E <br /> City: 4( Iica ), I County: 4.;„w I State: 0Q. I Zip: ill 73a''; <br /> Park Name:(if applicable) E This is a dealer lot or storage facility <br /> fl This home is being moved to a new location Complete the section below <br /> New Address: 4I2 S Yt,.4a. A . ...)e::: <br /> City: ,s.d.e,An County: M a r;o n I State: 0 CL i Zip: l i 3 a <br /> Park Name:(if applicable) fl This is a dealer lot or storage facility <br /> 1 Transporter Name: 11enelcI.1 Trt.Lit 1 l"Ansp.or-'/' Phone: 5W1 .37q 3yy� <br /> Address: P.GBo,x $�16 7 c1q City: (Anew I o{-{'t State: NC, <br /> Email: \Grp 13e.nA 4,44 a 0 no- <br /> 1 9 , <br /> 4 <br /> 440-2952(11/22/BCD) /•. ;g, Page 2 <br /> OR Title Application-7/2023-TitleApp1 I21 004823449-00001 <br />