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y , <br /> NATURE OF FILING (check all that applies) <br /> 011ain\cAspil • -r: t l\ ' r, o 44,: ., a .e • ' is' e , '.e <br /> c r : a r-.l or,p; \ .'e 4•v zg;rtorll r Pi��l4eV°'s`tatus j Trip permit o to owe <br /> M ': <br /> APPLICANT INFORMATION <br /> ■❑Dealer/seller ❑Lender ❑Escrow/title agent ❑ Owner/buyer ❑ Legal representative <br /> Name:CASCADE FACTORY HOMES, INC <br /> Address(including city,state,and ZIP):590 N. PACIFIC HWY,WOODBURN,OR 97071 <br /> Phone:(503)981-5314 <br /> Email:CASCADEHOMES@YAHOO.COM <br /> . HOME INFORMATION (*.required). • ... . .. <br /> Home ID number(if known): DMV X-plate number(if known): <br /> NEW Jl511 <br /> 1 - <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:FLEETWOOD HOMES Model:VW24362V Year:2019 <br /> Manufacturer serial number • <br /> HUD number <br /> FLE2100R19-19846A ORE 546637 <br /> FLE2100R19-19846B ORE 546638 <br /> *Number of sections:2 *Square footage: 839 *Number of bedrooms:2 *Number of bathrooms:2 <br /> *Type of roofing:COMPOSITIO *Type of siding:CEMENT *Heating:ELECTRIC *Cooling:NO <br /> *Date of sale: *Sales price:53,455.00 I *Includes land: ❑Yes %No <br /> DEALER INFORMATION (if no dealer, leave blank) <br /> Dealer name: Dealer license number: Dealer address and phone: <br /> CASCADE FACTORY HOMES, INC MSD-41 590 N. PACIFIC HWY <br /> WOODBURN,OR 97071 <br /> (503)981-5314 <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 /> CASCADE FACTORY HOMES, INC <br /> TRANSPORTER INFORMATION (If not moving, leave blank) <br /> Transporter name: Transporter address and phone: <br /> SUPERIOR HOME TRANSPORT 257 N. 6TH <br /> JEFFERSON, OR 97352 <br /> 541-327-7805 <br /> 440-2952(7/17/COM) Page 2 <br />