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rThr <br /> H '80 n Te-,1- e rS(sn -135 <br /> NATURE OF FILING (check all thatapplies) <br /> N t ct tyle er t %Change ownership * D' o ' ':n 8 to o • of 'os <br /> NazreNcIAD,34ceSnspare.ayL •m -al ••- stat ® I perm' M C• ed to <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: CASCADE FACTORY HOMES <br /> HOME INFORMATION (*required) :: <br /> Home ID number.(if known): DMV X-plate number(if known): <br /> 3(P aha <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: PALM HARBOR HOMES Model: 3104G28463A Year: 2020 <br /> Manufacturer serial number HUD number <br /> P 51c6D - 1 o s5-3 ® 4 4 <br /> *Number of sections: 2 *Square footage:1350 *Number of bedrooms: 3 *Number of bathrooms:2 <br /> *Type of roofing: ARCH SHING *Type of siding: CEMENT *Heating:ELECT *Cooling:N/A <br /> *Date of sale: Si114(c .o *Sales price: 78,967.00 *Includes land:❑Yes O 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 HW.Y <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 s• 'ury. <br /> Dealer name(print): Dealer Al ri Date: <br /> CASCADE FACTORY HOMES INC i `' 1I /2O2t <br /> TRANSPORTER INFORMATI (if not moving, leave.blank) <br /> Transporter name: Transporter address and phone: <br /> 440-2952(7/19/CUM) Page 2 <br />