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• T <br /> "NATURE QF FILING (check all that applies) <br /> than t U <br /> pr efty status (r!Trip permit ,�Genve `0''� to moorage <br /> ❑Oer: `�; <br /> APPLICANT INFORMATION <br /> 0 Dealer/seller ❑Lender ❑Escrow/title agent ❑ Owner/buyer ❑Legal representative <br /> Name:Windemere Meadows MHC LLC <br /> Address(including city,state,and ZIP):608 Windemere Street SE,Aumsville,Oregon 97325 <br /> Phone:503-749-4128 <br /> Email:windemere@ipgmhc.com <br /> :HOME INFORMATION rrequired) <br /> Home ID number(if known): DMV X-plate number(if known): <br /> v� '3 5 5 <br /> �� m 9 <br /> ❑Moving in from another state <br /> ,Has no home ID or X-plate because: ❑Coming out of county deed records <br /> ❑Other: <br /> Manufacturer:Fleetwood Model:WC28603W Year:2017 <br /> Manufacturer serial number HUD number <br /> 2F-91-0250-K A/B <br /> *Number of sections:2 *Square footage:1620 *Number of bedrooms:4 *Number of bathrooms:2 <br /> *Type of roofing:Architectural *Type of siding:Hardiboard *Heating:Furnace *Cooling:N/A <br /> *Date of sale: *Sales price: *Includes land:❑Yes CI No <br /> DEALER INFORMATION;(if nodealer, leave blank) • <br /> Dealer name: `Dealer license number: Dealer address and phone: <br /> Brian L. Fitterer, Inc. MSD410 18006 Sky Park Circle <br /> Suite#200 <br /> Irvine, CA.92614 <br /> 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. <br /> I hereby declare that the above statement is true to the best of my knowledge and belief,and that I understand it is <br /> made for use as evidence in court and is subject to penalty for perjury. <br /> Dealer name (print): Dealer signature. Date: <br /> Brian L. Fitterer, Inc.by Christopher Ruiz 1 I,- , I I — 9c17 <br /> TRANSPORTER INFORMATION (if no moving, leave blank) <br /> Transporter name: Transporter address and phone: <br /> Doug's Mobile Home Service, Inc. 12692 Fry Road NE � <br /> Aurora, Oregon 97002 TY ? e-e Vvr i <br /> 440-2952(7/1 7/COM) Page 2 To 5 S c4 Y <br />