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NATURE OF FILING ;checkall that a lies <br /> ty-hia-est n ^hang,o 1, a '•ip 0 Dcmolition Date of demolition: <br /> f p ..aa I K.043 rhi E • is ii Trip permit tarage <br /> APPLICANT INFORMATION <br /> ❑l 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 /> NEv.r ('Y\35543c <br /> E Moving in from another state <br /> Has no home 1D 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 /> 2F91-0457-K-NB <br /> *Number of sections:2 *Square footage: 1680 *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 jJ No <br /> DEALER INFORMATION'(if.rib•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 /> OThis 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 per' y. <br /> Dealer name (print): Dealer sign re: Date: <br /> Brian L. Fitterer, Inc. by Christopher Ruiz (. � 5-/pipe <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 />