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<br /> SECTIO 1 NXTURE.OF FILIN (dledc all that a
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<br /> e e Recording�,as��real p ,j � .9. .:-I..I ,.
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<br /> .SECTION.2.. : APPLICANT INFORMA 'ON teaseprint)
<br /> ar 15 ealer/Seller ❑Lender ❑Escrow/Title Agent ❑Owner/Buyer ElLegal Representative _
<br /> Name: � '* _
<br /> (first.middle,last) 0.int1� �c 4rt�.. �y t� fi.4-G Phone:
<br /> _ fn�r L- s �3 .c-b2.70
<br /> Address: l�12'7 I S LA,14(,Le 'F 1 elf) C J
<br /> City: 7p 2TZ,A-0.,0 J State: D, I ZIP: 4 z _
<br /> � z
<br /> Email: 1 h.Q v t du N Fe b, h o wc-e S �40 G,,,,,. l • Co
<br /> SECTION 3. HOME INFORMATION(informationin bold is required)
<br /> Home ID#: OR No Home ID: New Home ❑Out of state home 0 Leaving County Deed Records
<br /> Manufacturer: 'F Cam,,-- md4--
<br /> Model: Year
<br /> Serial Number(s)c HUD Label Number(s)*Required if new home
<br /> G All 21 V A2 2 C-. 2 S`5 t2A— 6t2 S-7 p (,A,4
<br /> CAI/ 2lc) pYL 2 S- 2 S' S 8Z 6 O(2-e- S'-'7ta LeCe c-
<br /> #of Sections: 'Z.- Sq.footage: I 7 6-V Bedrooms: Bathrooms:
<br /> Rooting type: c O wt e Siding type: C4e., . Heating type: Q-L g_L . Cooling type:
<br /> Date of sale:
<br /> afappliaaale) /"'2.Y-2 4 Sale price: 9 4(3 7,d' Includes land: ❑Yes FNo
<br /> SECTION.4
<br /> DEALER INFORMATION(leave blank if no dealer)
<br /> Name:
<br /> te(first,middle,last) ' r t etlid.%.. I-7 4 - ail P ter+ I License#: �d5
<br /> Address: L}y© F g# I�4„I �i-
<br /> City: S fit—2/4 Al-sv I State: DlZ_ ZIP: 9 7,v 7 -
<br /> Email: 5 4E-iet•O 4U �,9-+c7"2►@(iacb•i�� 99., ziritcl .tomhone: Sa 3 • 7cd$
<br /> I hereby declare this manufactured structure is free and clear of all mortgages,deeds of trust,security interests,and lien��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 ands be used as ev. e in court and is subject to a penalty of perjury.
<br /> Signatur Date:
<br /> SECTION 5. .
<br /> ... .: HOME LOCATION
<br /> Current Address: a(, TT" Pr D%y,-4* g S 'l.J yl.v,
<br /> City: 4.'Gd ./et 10a� rt I county_. ( Il..(A✓scyyl. I State: D— I Zip: 1 70 7!
<br /> Park Name:(f applicable)
<br /> ❑This is a dealer lot or storage facility
<br /> [f tis home is being moved to a new location Complete the section below
<br /> New Address: /4 c 7v #14,, pQE ti4-
<br /> City:! )opal bu+[ w I County: /tie r(a.,,,-- I State: 0� I Zip: 974 7(
<br /> Park Name:(f applicable)
<br /> ❑This is a dealer lot or storage facility
<br /> Transporter Name: Uu al s itetiolej"t j _
<br /> 1.�, Sawa e....12__ Phone:S'03.791- 4S',51=
<br /> Address: /,,2, (e2 City. k24•< State: BC
<br /> Email:
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