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Doousign EnvelopeNcia\ch ID:76485617-CAF1-433E-A37E-8BFC7541EEB6341 Ail 31 _PetLiJ <br /> SECTION 1 NATURE OF FILING (check all that a ply) <br /> tO/�N h to 0 S Ic2' I ov og ner e 'ate: ) <br /> ❑X Used home sale [ eZ rd' a r ropQrt3► ve elrage <br /> IZNAtotiattyafewttigange 1.1-1-m)heit m al o rty status ❑X Trip Permit <br /> ra er inh�f6t nce e• - 'lea e note): <br /> SECTION 2 APPLICANT INFORMATION (please print) <br /> ❑ Dealer/Seller ri Lender ❑X Escrow/Title Agent El Owner/Buyer ❑ Legal Representative <br /> Name: First American Title Insurance Company Phone: (503)581-0555 <br /> (first;middle,last) <br /> Address: 777 Commercial Street SE, Suite 100 <br /> City: Salem State: OR ZIP:97301 <br /> Email: mgirod@firstam.com <br /> _ SECTION 3 HOME INFORMATION (information in bold is required) <br /> Home ID#: 396510 OR No Home ID:n New Home❑ Out of state home n Leaving County Deed Records <br /> Manufacturer:Fleetwood Homes L(,* -rb O <br /> Model:Wellington Year:2018 <br /> Serial Number(s) HUD Label Number(s) *Required if new home <br /> FLE2100R18-19041 ORE 541596 <br /> FLE2100R18-19041 • ORE 541597 <br /> #of Sections: 2 1 Sq.footage: 1280 Bedrooms:.2 . Bathrooms: 2 <br /> Roofing type: Architectural Siding type: Vertical Heating type: Electric Cooling type: None <br /> Composition Cement <br /> Composition <br /> Date of sale: di- I�r Sale price: 58,000.00 Indudes land: ri Yes Li No <br /> (If applicable) <br /> SECTION 4 DEALER INFORMATION (leave blank if no dealer) <br /> Name: License#: <br /> (first,middle,last) <br /> Address: <br /> City: State: _ ZIP: <br /> Email: Phone: <br /> I hereby declare this manufactured structure is free and dear 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 belief, <br /> and I understand it can be used as evidence in court and is subject to a penalty of perjury. <br /> Signature: Date: <br /> SECTION 5 HOME LOCATION <br /> Current Address:11 Siaq St- <br /> City:C ,J County: ( S I State:OR <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: 34 lefi 17,in AA(,k E <br /> City: 5-, Pe 1 County: ne‘..O % art State: (r. Zip -131 _ <br /> Park Name: (if applicable) ❑ This is a dealer lot or storage facility <br /> Transporter Name: q,S®r a vl vt,S4 C Phone: so_ ! '3— <br /> Address: City: _ State: <br /> Email:j I.Ic-Paw reel COOA <br /> Page 2 <br />