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, , . ) <br /> - 1 <br /> Docusign Envelope ID:C065CA2GAO4E-4E4D-9131-373F9C76E16B <br /> e , 4 , me_ , I0 <br /> 1624182 1 bit, <br /> SECTION 1 - NATURE OF FILING(check all that apply) <br /> A h We S Or er <br /> ElW. e g <br /> a Trip Permit <br /> er(p see ): <br /> SECT 2 APPLICANT INFORMATION(ply pint) <br /> %Dealer/Seller E Leader C Escrow/Title Agent El Ovmerr/Buyer E Legal Representative <br /> Name <br /> 61,-,4,„iddk3.0 .. 0 I at,kta I- <br /> Address: .t.4 e : t ,.. 0 a <br /> p CCi�tryy _ .. State. k_..- ZIP: fi 1 ' ,-- <br /> SECTION 3 NO E INFORMATION.(b n„„„thm h bold h regliked) <br /> Home ID# ;. . OR No Home ID:0 New Home Out of state home . Co <br /> • �Leaving >aatyDeed:Records <br /> Manufaetmer:'TH60117 (0. j D-;b <br /> Model: 72TRL2g603A1325 l Year: 2025 <br /> Serial Number(s) HUD Label Number(s)*Required If new home <br /> • ALB044507ORA.CAC . <br /> #of Sections <br /> Sq.footage: (. tiled veins: Bathrooms: ,.-- <br /> Roofing type f <br /> '\c It Siding type: i.e .hrgi%" g type Cooling ;#�� <br /> -.,. Date ofsale � J to es tT <br /> RP Pttcaale) Sale price: Includes land: ❑Yes E Na <br /> SECTION 4 DEALER INFORMATION. <br /> • Cleave blank If no dealer)_ <br /> Name CLA�'TON HOMES ALBANY OR <br /> OrsR middle,tom' -, ' Liars � $ <br /> Address .1437 CENTURY DRIVE NE ; C 3 <br /> City ALBANY State: OR ZIP. . ...97322 ...,: <br /> Email: C. :.n' , i sn w.I c r 4 / <br /> Phone: (541)967-5535 <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: [ijq Date: 12/12/2025 <br /> SECTION 5 °°' ''''.''",.' NOME LOCATION <br /> Current Address: {.ji,.1- ( -)"f ,,Pt 'i <br /> City: f I i n ts- County: k '1 i 0 .. State: ) ( Zip:( � 7 <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: ieran a <br /> .= City: G/ 1/■L., ! County: State: i Zip: <br /> Paris Name:(if applicable) (` `� <br /> 's is a dealer lo or storage facility <br /> Transporter Name: , /I to , `_. t - y , <br /> AdEdmteaS�. �t: a ci t t 1r�f C State: (i. <br /> t s 1 <br /> 440-2952(11r22/BCD) Page 2 <br /> OR Title Application-9/2024-TitleApp11211 00505630240005 <br />