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B GJ Thi Rd. 6ale,5 9 *-7 <br /> 1 SECTION 1 NATURE OF FILING(checkalithatapply) <br /> ❑ New home to MHODS ❑ Adding or removing a co-owner 0 Demolition(Date: ) <br /> ❑ Used home sale ❑ Recording as real property 0 Converted to storage <br /> 0 Security interest change ❑ Removing from real property status ISI Trip Permit <br /> ❑ Transfer by inheritance ❑ Other(please note): <br /> SECTION 2 - 'APPLICANT INFORMATION(please print) <br /> ®Dealer/Seller ❑Lender ❑Escrow/Title Agent ❑Owner/Buyer 0 Legal Representative <br /> _(firsr,middle,la <br /> Namss)e:DOug s mobile home service inc Phone:503-799-0539 <br /> Address:12692 fry rd ne <br /> city:Aurora State:OR ZrP:97002 <br /> Email:dugwalton@aol.com <br /> SECTION 3 .. HOME INFORMATION(information In bold is required) <br /> Home ID It:.3,2- ._l 1-1.- OR No Home ID: 0 New Home 0 Out of state homer Leaving County Deed Records <br /> Manufacturer: Coin <br /> l i R(I), <br /> Model: Year: 1 (I 7 q <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> 6 f CAL G J-3 23-7, <br /> 6 ,( « ,.67337 <br /> #of Sections: Sq.footage: f 1,44,6, Bedrooms: :2_ Bathrooms: . 2_. <br /> Roofing type: 6,.. , Siding type: (4),..- x Beating type: cilex,r Cooling type: <br /> Date of sale: �`�`L <br /> ofapplkable) 3 j- Sale price: 7�L,c > Includes land: ❑Yes 0 No <br /> SECTION 4 DEALER INFORMATION(leave blank if no dealer) <br /> Na1eCDOU Walton License#:MSD 652 <br /> (tint,middle,last) 9 <br /> Address:12692 Fry rd ne <br /> city:Aurora State:OR ZIP:97002 <br /> Email:dugwalton@aol.com Phone:503-799-0539 _ <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' can be used as evidence in court and is subject to a penalty of perjury. <br /> Signature: / e,,, 6,,t_jee.„ , _ Date: 3 mil'-22'a <br /> SECTION 5 HOME LOCATION <br /> Current Address:$Li&c,Le_N i f_G (< .., euze_ rr <br /> City: 6 i�y t' gt-to t.. . County: do...04%4.4415 State: Zip 7oic3 <br /> Park Name:(if applicable) 0 This is a dealer lot or storage facility <br /> 0 This home is being moved to a new location Complete the section below <br /> t ' New Address: 1 1 (St <br /> a , CI 5 Hitt i2 <br /> 4E - <br /> City: 6 .5 County: .& (tf) State: Zip:g 73 Li-t <br /> Park Name:(if applicable) ❑This is a dealer lot or storage facility <br /> Transporter Name:Dougs mobile home service inc Phone:503-799-0539 _ <br /> Address:12692 Fry rd ne city: Aurora State: OR <br /> Email:dugwalton@aol.com <br /> Page 2 <br />