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Oct•18 19,p3:24p Dougs Mobile Home Service 503-200-1299 p.2 10/ f <br /> , <br /> ` <br /> NATURE OF-FiLiNG (check al that applies) - <br /> C nge ec 1 0 Change ownership ` e o ' on <br /> r�-e- c//��d r �`'�i�eLt.,. m 1 Trip permit to .ge <br /> = APPLICANT INFORMU A lON • - _ - <br /> ®Q Dealer/seller , 0 Lender J 0 Escrow/title agent 1 0 Owner/buyer <br /> 1 ❑Legal representative <br /> Name:Dougs Mobile Home Service INC <br /> Address(including city,state,and ZIP):12692 Fry rd Aurora or 97002 <br /> Phone;503-799-0539 <br /> EmaiE dugwaltondaol com <br /> .._ - HOME INFORMATION (* required "-- <br /> Home ID number(if known). DMV X-plate number(if known): <br /> Z1/1 (;7) -L 7 <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: r/ 7`Ce,e f Model: <br /> Year: j GI <br /> Manufacturer serial number I HUD number <br /> 4-e—&—Zi...1-2Cr.A. _ - <br /> U— C.5Z FL. Zvl3f A.6 /0f a c, 1 <br /> Number of sections: 1 *Square footage: 1 %1 *Number of bedrooms: 3 1*Number of bathrooms: <br /> *Type of roofing: 1 *Type of siding: *Heating:C � I '�� �� ( � � Hig' _/e c.?' 1 Cooling: � <br /> *Date of sale: . — ` �./G Sales ricer <br /> O -. - [� L C � * P i rJ �6 6� Includes land:0 Yes [J No <br /> . <br /> : <br /> DEALER INFORMATION:(if no-stealer, leave,blank) <br /> Dealer name. . . <br /> Dealer license number: Dealer address and phone: <br /> Dougs Mobile Home Service INC 652 12692 Fry rd Aurora or 97002 <br /> 503-799-0539 <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): i Dealer ' e: i Date: <br /> Doug Walton <br /> _ 0--)E.de, I 4-7-1 7-49 <br /> TRANSPORTER INFORMATION (if t moving, leave blank) <br /> Transporter name: Transporter address andhone; <br /> Dougs Mobile Home Service INC : 12692 Fry rd Aurora or 97002 <br /> I <br /> 440-2952(7/I71COM) Page 2 <br />