Laserfiche WebLink
I 1 a 14-61 ,Letne SE 1-on <br /> 1349979 <br /> NATURE OF FILING(cherall that applies) <br /> �L t ine L ar o er t c .o to . <br /> Ntty‘kgriot [1 s e • o. 4 r, ,• - /Trip OttiootRo.isituagp <br /> Rot <br /> APPLICANT INFORMATION <br /> 0 Dealer/seller ❑Lender ❑Escrow/title agent J'Owner/biuyer ❑Legal representative <br /> Name: Daniel Lee Beougher and Christi Dawn Beougher <br /> Address(including city,state,and ZIP): 11214'HOLDUP LANE SE STAYTON OR 973.83 <br /> Phone: <6)3- S70-15 <br /> Email: <br /> HOME INFORMATION(*required) <br /> Home ID number(ifInrown): �� DMV X-plate number(if known): <br /> Nr ' m35841C, <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: CMH Model:. Year:2019 <br /> Manufacturer serial number - HUD number <br /> ALB038913ORAB <br /> *Number of sections: 2 !Square footage; 60 *Numberof bedrooms: ( *Number of bathrooms:2 <br /> *Type of roofing:{;ifG(-s *Type of sidingbvwrl' .,.,-,n,eI *'Heating: C. *'Cooling: f r- <br /> •Date of sale: *Sales pricei)70 , *includes land: ❑ <br /> Yesa4 <br /> I • . DEALER INFORMATION (if no dealer,leave blank) <br /> Maier name: Dealer 1 Fens e�Ltl3t Ar3D195Dealer address and phone: <br /> CLAYTON HOMES ALBANY,OR CCB #166990 J 1437 CENTURY'DRIVE NE <br /> ALBANY OR 97321 <br /> (541)967-8555 <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 <br /> is made for use as evidence in court and Is.subject to penalty for perjury. <br /> Dealer name(print): Dealerrsignature: Date: <br /> & J:J(11n ill :i '; t Ll.eS i;1 ,1l P i 3,-Vkdver 1Dl-15 11 <br /> TRANSPORTER INFORMATION(if not moving,leave blank) <br /> Transporter name: Transporter address and phone: 81e- 6j3t f_ 5-S*21 I <br /> tte 140A-K. a r <br /> • <br /> 440:2952(7/I7/COM) <br /> OR Title Application-10/2018-TitleApp11211 Page•2 004186486-00001 <br />