Laserfiche WebLink
: , <br /> , <br /> 1, 0(51 a I,a,keu00od C-1-- Me A-kkvc) irq . .. <br /> SECTION 1 NATURE OF FILING(check all that apply) <br /> OS New home to MI IODS t ,• _a cr �c l?iiatf('Nale:__ __) - <br /> fakkotne-fille I .c ciin t t heam u cr tit-tolkuage <br /> c i_e I tei 'n, op••- s. us I fp Trip Permit <br /> { SECTION 2'' '' APPLICANT INFORMATION(please print) <br /> 0 Dealer/Seller 0 Lender 0 EscrowffitleAltent ►a Owner/Buyer 0 Legal Representative <br /> Name: �f� , ,, <br /> 4 , flirs/..middic.,fas 1 0 2� � "['[K �.0 <br /> Address: <br /> City: -C --1 State: ZIP: I <br /> Email: ?...1(1 rt'tat X u i)a�pi l l� 4N� 'NW MC:N <br /> SECTION 3 HOME IN,FORMTIO' (information in bold is required) <br /> Home II?,N:i,J'E f OR No I tonie ID: g7 New Home ❑allot-state home.0 Leaving County Deed Records <br /> Manufacturer: ee} p�• ( 1 i 3 7 B <br /> Model: `, •� Year: -atj .S. <br /> Serial.Nuntber(s) I HUD Label Number(s)*Required if new home <br /> ! <br /> A'ofSections: I . if Sq.footage: \ _ j Bedrooms: Bathrooms: <br /> Roofing type: A4 4, I Siding type: ,t�� Heating hype: , Cooling type: 6 <br /> Date of sale: en .a a�� 1 Sale price:f``asy % I Includes land: El Yes ►�y No <br /> flfafry,liccfi>Jr� ` t <br /> SECTION 4- DEALER INFORMATION(leave blank tf no dealer) . <br /> Name: <br /> ffrsr,nil:lt,last). 0G . rr\a, ia. 4.,.±vY- License 4 <br /> ense : <br /> Address: . . y —A 1"l(.n . <br /> City: 'co cx,Lcx• 1,..‘ j State: pQ ZIP: Onbtar. <br /> Phon ri. -11 y Email: ���.�'�°�-a'e ' "��S1+ftnAS t�i,']• corn � .� <br /> I hereby declare this manufactured structure is free and clear oral!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 /> Sitmaturc: Date: <br /> SECTION 5 HOME LOCATION <br /> Current Address: („J2cS eR Q C QJc„ , (� <br /> City; LK cc\ I County. State: V' Zip: I <br /> Park Name:Of 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: t q i`?' La Kr, 1/4`.`Cjr.01 C Jr S\,)G <br /> City: 1�-tvi t'i 7 Y a County: VY' cL r i 0 Cl j State: i3 Fs I Zip:C.(.7>30-D., <br /> Park Name:((fapplicahle) L_. e-14- CjO( 0 This is a dealer lot or storage facility <br /> Transporter Name: ` • iii lb i , ,a` t S(/. Phone. 0 : di i ® >•, S't• <br /> i Address: \NL.Zioet% _EA. '@ 3 (( ,City: • I State: (Ile.Email: 1, e& 'tor\G _i <br /> i. <br /> Page 2 <br />