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<br /> 1 Other:MOVING.TO MARION CO.
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<br /> El Dee I er/sel ler, I 0 Lender 1 E]Esc 9w/title agent El Owner/buyer. .ID Legal representative
<br /> Name: .11.• ; .. . .. .2- • / 1 i J.-`? ; r ___. •
<br /> ___ •
<br /> Address(including city,state,and ZIP ; • • • , .1 oa, () -4 c` / :' J.), ,406;‘1',E:.. !. .. 0, Ai 411:: , , •A
<br /> Phone; 1x-,; _ 0 I . 72
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<br /> Email: 1\k‘,e9Ctf-,-1--.-e_ •(4). CS , (\e-4-- • 1 , -
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<br /> Home ID number(if known): • DMV X-plate number(If known): -
<br /> 313803
<br /> - M355 P.-7 5 pENAJ ,
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<br /> 0 Moving in from another state •
<br /> Has no home 1D or X-plate because: . 0 Coming out of county deed records
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<br /> ['Other:
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<br /> • - - • • .-- 2006 '
<br /> MYear:anufacturer:PALM HARBOR HOMES I Model: •
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<br /> Manufacturer serial number I • : BPD number
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<br /> PH20-8664A/B
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<br /> *Number of sections:2 *Square footage: 1566 *Number of bedrooms;3 1 *Number of bathrooMs:2
<br /> *Type of roofing:COMP *Type of siding:T1-11 1 *Heating:ELECT *Cooling:NONE
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<br /> *Date of sale:':1:/_19./26 •t8' 1.*Sales price:32,000--- 1*Includes land:[1:1 Yes El No
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<br /> - Dealer name: Dealer license number:- Dealer address and phone:
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<br /> 0 This manufactured structure is free and clear of all mortgages, deeds of trust,s,ecurity 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 d3rint): • Dealer signature: Date::
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<br /> Transporter narne: Transporter ilme§§.dfrd:plione! : . . ;
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<br /> (Q-110/11-2, (1.,,' --Z.)1X- 1 09.-0(709
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<br /> 440-2952(711 7/COM) - Page 2 50 ...7 ."" --riei 42 .•
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