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lases --17,4..11-i; Greeks Ln U� 1- Y,SOil <br /> b <br /> 1326001 <br /> : . '-, NATURE OF FILING (check all that applies) ' : <br /> r_Skvevonszitrietst a o r 1ip„.- Ekpi t' <br /> s 1 rep: " 7 c ', ,,, . ,1:4j1/ . , sy,�{Trip permit [� 5 t orage <br /> Ear: <br /> - =, APPLICANT INF RM TION, , • :1, <br /> 0 Dealer/seller 0 Lender 0 Escrow/title agent Owner/buyer 0 Legal representative <br /> Name:Thomas Pilcher and Susan Pitcher <br /> Address(including city,state,and ZIP): 12505 TWIN CREEK LANE JEFFERSON OR 97352 <br /> Phone: <br /> Email: <br /> HOME'INFORMATION(*required)' <br /> Home ID number(if known): DMV X-plate number(if known <br /> n. <br /> Nil Evi <br /> 0 Moving in from another state <br /> Has no home ID or X-plate because: n Coming out of county deed records <br /> 11 Other: <br /> Manufacturer: CLAYTON Model: Year:2019 <br /> Manufacturer'serial number` • HUD number <br /> ALB038575ORAB <br /> • <br /> *Number of sections: 2 *Square footage:2,z4-0 *Number of bedrooms: 3 *Number of bathrooms: Z <br /> *Type of roofing: /;,-, _ *Type of siding: tr, pzp ,, *Heating: ,u *Cooling: <br /> *Date of sale: S.� j *Sales price: 1-/5-q y-i z *Includes land: 0 Yes 0 No <br /> DEALER INFORMATION.(if no dealer, leave:blank) <br /> Dealer name: Dealer license number: Dealer address and phone: <br /> CLAYTON HOMES ALBANY,OR MS6 19 5 1437 CENTURY DRIVE NE <br /> ALBANY OR 97321 <br /> (541)967-8555 <br /> 0 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 <br /> is made for use as evidence in court and is subject to penalty for perjury. <br /> Dealer name(print): Dealer. ignat ire: Date: - <br /> W ar Q. +f - ( .s 6 l/ <br /> TRANSPORTER INFORMATION1(if not moving, leave blank) <br /> Transporter name: Transporter address and phone: <br /> 81 Fid' -4i3V_S s-o 1 <br /> 440-2952(7/17/COM) - <br /> OR Title Application-10/2018-TitleApp11211 Page 2 004152393-00001 <br />