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• NATURE OF FILING (check all that applies) <br /> aloekliftsessit~st 0 Change ownership MANDAVsn yeaxelasokaisori: <br /> s 0 Trip permit <br /> APPLICANT INFORMATION <br /> ®Dealer/seller ❑Lender I D Escrow/title agent ❑ Owner/buyer ❑ 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 /> Email:dugwalton@aol.com <br /> HOME INFORMATION (* required) <br /> Home ID number(if known): DMV X-plate number(if known): <br /> ❑Moving in from another state <br /> Has no home ID or X-plate because: ❑Corning out of county deed records <br /> ❑Other: <br /> Manufacturer: Fr/-�Tu_ec> Model: Year:/C.1 <br /> Manufacturer serial number BUD number < <br /> Rtt\. 3 <br /> *Number of sections: t *Square footage:6"7 L *Number of bedrooms: Number of bathrooms: , <br /> '`Type of roofing: C <br /> o <br /> -1 <br /> *Type of siding: _Ti t 1 ~Heating: [e_e_4- 'Cooling: $- <br /> *Date of sale: 7,1_17 *Sales price: -7 0-0 flP'" *Includes land:ElYes p3I'o <br /> • DEALER INFORMATION (if no dealer, leave blank) <br /> Dealer name: Dealer license number: Dealer address and phone: <br /> Dougs Mobile Home Service !NC 652 12692 Fry rd Aurora or 97002 <br /> 503-799-0539 <br /> 15g 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 si Date: <br /> Doug Walton . . I <br /> TRANSPORTER INFORMATION (if n : moving, leave blank) <br /> Transporter name: Transporter address and phone: <br /> Dougs Mobile Home Service INC 12692 Fry rd Aurora or 97002 <br /> 440-2952(7/17/CONI) Page 2 <br /> d 66Z L-00Z-£05 eovueg euwoH ellgo j s6noa dLZ:170`66 ZO Inr <br />