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ovi AL\ VO0: Lo 1 `,"( I v,Nr reto v. r\k- Lang-, 40-u 0 i2 01130 <br /> SECTION 1 NATURE OF FILING (check all that apply) <br /> ❑ New home to MHODS ❑ Adding or removing a co-owner ❑ Demolition(Date: ) <br /> 0 Used home sale ❑ Recording as real property ❑ Converted to storage <br /> ❑ Security interest change ❑ Removing from real property status °l Trip Permit <br /> D Transfer by inheritance ❑ Other(please note): // �� <br /> SECTION 2 APPLICANT INFORMATION (please print) <br /> ❑Dealer/Seller ❑Lender ❑Escrow/Title Agent 0 Owner/Buyer ❑Legal Representative <br /> Name:Realty Systems Arizona, Inc Phone:503-657-9171 <br /> (first,middle, last) y y <br /> Address:7310 N. 16th Street, Ste #300 <br /> City: Phoenix State: Arizona ZIP: 85020 <br /> Email:rose_hansen@equitylifestyle.com <br /> SECTION 3 HOME INFORMATION (information in bold is required) Co ! 9 <br /> Home ID#:218126 OR No Home ID: ❑New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer: WeStwind <br /> Model: Unknown Year: 1977 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> 5129 <br /> #of Sections: Sq.footage: 1344 Bedrooms: 3 Bathrooms: 2 <br /> Roofing type: composition Siding type: Lap Metal Heating type: Heat Pump Cooling type: Heat Pump <br /> Date of sale: f q rice:j t /a Sale <br /> (If applicable) I P 20,000 Includes land: Yes ❑■ No <br /> SECTION 4 DEALER INFORMATION (leave blank if no dealer) <br /> Name: Realty Systems Arizona, Inc License#: MSD58 <br /> Mist,middle,last) <br /> Address: 7310 N. 16th Street, Ste #300 <br /> city: Phoenix State: Arizona ZIP: 85020 <br /> Email:rose_hansen@equitylifestyle.com Phone: 503-657-9171 <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 vidence in court and is subject to a penalty of perjury. <br /> Signatu• • Date: 4/( J 1.(/ <br /> SECTION 5 HOME LOCATION 1 <br /> Current Address:13640 SE Highway 212 Space #130 <br /> city: Clackamas County: Clackamas State: Oregon Zip: 97015 <br /> Park Name: (if applicable) Shadowbrook ❑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: 4 4/y7 g/o/21f 4 N1G 1 4,n,IL- <br /> City: 1� CA Z. County: AthL1' ' State: crilk Zip:`'/) 03 <br /> Park Name: (if applicable) ❑This is a dealer lot or storage facility <br /> Transporter Name: th, ; o4e,„ Aeie J,L,c,be Phone; -7 3 7 <br /> Address: Fry Rel City: r State: 0 r, <br /> Email: a c7 ram'' 'P76, (LC) //+e4,77.41 <br /> ✓' <br /> Page 2 <br />