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-•NATURE,OF FILING (check all that-applies)., <br /> ri Da • G. - e • •'. <br /> r—]n rd a.1 arty - • - : . :: -. .s 0 Trip permit n ne ....ted to ato age <br /> ❑-ether: <br /> APPLICANT, INFORMATION <br /> ❑■ 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'(* required)_;; <br /> Home ID number(if known): DMV X-plate number(if known): <br /> Ner355a5,1 NEW' <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:Skyline Model:West Ridge Year:2017 <br /> Manufacturer serial number - HUD number <br /> 2F91-0368-K-NB ORE 539859/ORE 839860 <br /> *Number * *Numberbedrooms:3 *Number of bathrooms:2 <br /> of sections:2 Square footage: 1512 of <br /> *Type of roofing:Architectural *Type of siding:Hardiboard *Heating:Furnace *Cooling:N/A <br /> *Date of sale: *Sales price: *Includes land: ❑Yes ❑■ No <br /> DEALER INFORMATION (if no_ `dealer, 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 <br /> TRANSPORTER INFORMATION (if not 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 <br /> 440-2952(7/17/COM) Page 2 <br />