|
, .
<br /> .."-lq lo 5Linn ,c \ ) ,R ,'1 4)- B ./,,, c t.,::-::
<br /> ,,) ) c -e v.., r L•••"'
<br /> DocuSign Envelope ID:F0A9D597-D0A6-4A14-8082-5EEA46CC1CAD ' N
<br /> C'.,1Q.-��
<br /> t+- t s _.ry; A,-.
<br /> ..,,�„ .✓„. .`s .`w`, "� - ;r _.y,.a....r° .'L+ '' � +••°,_]tea,
<br /> 3.: r'' :u3_a'/I'): '-7..:0 ' ,'sty 7'1. '''."'`'''',,4S`
<br /> YB,, ..i.,,.---„,,,.,6,-,-,-y'+fi <,t. aL. �r_; ar..r_ ij7 p -,i: §' rm C�44,5 s. ` K i
<br /> i Jtr"+Y. .r,�` 'If. Fs`K=,�;i .a' a, n r,�5? -d, Nn a *% - �y-r.:. . tea y "' ��>5F',,PrJiil_?zj.,,t,
<br /> El Change seonrity-interest 0 Change ownership ❑—e`Triolition Date-of-4emelition:
<br /> ❑-Reeordi g.as=real=preperty I ❑.>3.emo©'ing front-re,alzproprrty.status I ®Trip permit I ❑-C verte.dtto-storage
<br /> 0-lather:
<br /> edFtr�i �xK t''J•�� A x r�i�`4:f`n Y 1v's t4f m 9� 11..� ' ���y�yi :,--‘2.,
<br /> � .e✓ .S�.�' f -: _t Z.a.�
<br /> JRNAWII
<br /> ❑Dealer/seller ❑Lender ❑Escrow/title agent El Owner/buyer ❑Legal representative
<br /> Name:CORA HYATT/SUSAN CONOVER
<br /> Address(including city,state,and ZIP):5345 NORMA AVE SE SALEM OR 97306
<br /> Phone:503-508-8959
<br /> Email:
<br /> +!• -.y' T r&a +rn s`r'3 c J�.�,�.i > +.�.rf.a..F�lu {7+��f -` ,'stir t+'� f '1 r�, 4�d 7-1.z, F re.+ 2r'�+ q�, s.-,-1.-4„--, iL
<br /> .....-.,-,,--3,4“4-. t r , �J w ° s.3 s t3k�J L e� t , A. .' k E',k.*,,,--, o e ,,„,eq; x 3� .,,, t
<br /> �.TA - inf r a- 4 IIS Y :. Z ,1 -J£�: a, F' It ,A d a:
<br /> Home ID number(if known): • DMV X-plate number(if known):'In 3 5 (g 0 5,"„
<br /> :I E W N 6 V
<br /> ❑Moving in from another state
<br /> Has no home ID or X-plate because: ❑Coming out of county deed records
<br /> •
<br /> • ❑Other:
<br /> Manufacturer:SKYLINE I Model:MICRO I Year:2019
<br /> ._Manufacturerseralnunber.`.';.'>.'.. _ : ::HUD number
<br /> - KW91-0226-L ORE 543012
<br /> •
<br /> *Number of sections:1 I *Square footage:437 I *Number of bedrooms:1 I *Number of bathrooms:1
<br /> *Type of roofing:ACCH COMP I *Type of siding:ACCH CEMENT I *Heating:ELECTRIC I *Cooling:NONE
<br /> 1 *Date of sale:5-30-2018 I *Sales price:21,900.00 I *Includes land:El Yes j No
<br /> ,�j �ti��<
<br /> r67 j ,zh_ n'.iYP`f pm >” .+. i.€¢'.{a jrt• ,,rs,t,td.f �,o a :.kwv , ,y .% .) ., .. ®�wAre i ?' .? 0.''' -
<br /> Dealer name: Dealer license number: Dealer address and phone:
<br /> ALTA CIMA DBA MSS382 PO BOX 1295
<br /> FACTORY EXPO.HOMES MCMINNVILLE OR,97128
<br /> 971-267-5020
<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 itis
<br /> ' made for use as evidence in court and is subject to penalty for perjury.
<br /> Dealer name(print): o) signature: Date:
<br /> 1. . Qa t& 10/4/2018 I 4:04 P'4 MST
<br /> FACTORY EXPO HOMES 'D�-
<br /> t ,j 9girt% S ti Se " L,{ ,°;',AS; ,,y;9.n '''-if ," •• W-
<br /> —440
<br /> 1 S „,_;.,-'7,4;-',1:,15k , K jt Ti1H - -J,1e3ki9) r7 r'{�, 64 q'y ;',ASPA”
<br /> 1 F to ' 4,
<br /> f d` t"� ,YL`r`,yp.:144,--1..64.,',.r �2 A'-8-4,4 - F-. ,,y, .rF1 4EJ3 8 As-• rt•"rr` a ,, 4'' , y;-';s r.',35,t`a;
<br /> � ��x dSs.,dx•.Tcb. ",i,Y,�.._Z.caaL4..dAY:�,.s�tf.�� �+: 'SCI'NI.P,i�f's'.,�.�'..�vs,a:d��aw
<br /> Transporter name: Transporter address and phone:
<br /> SUPERIOR HOME TRANSPORT 257 N 6TH ST
<br /> JEFFERSON OR 97352
<br /> 503-551-3454
<br /> 440-2952(7/17/COM) Page 2
<br />
|