SET UP Application # to 4 ..-1° 27 d) `7
. Harnett County Central Permitting
PO Box 65 Lillington, NC 27548
Telephone Number: 910-893-7525 Fax 910- 893 -2793 www.hamett.orglpermits
' • •, Application for Manufactumd Horne Set•llo Permit
(Please fill out each part completely)
Part I -Owner Information:
Home Owner Information be completed by owner of the manufactured home)
Name: Jt*10n kIIYJS l . Address: 7a Co 0 I 5pri ? t {
City: pro a '`1 State: }S CJ Zip: 411.505 Daytime Phone: OI1) 7q 9 A/99
II
Landowner Information (To be completed by landowner, H different than above)
Name: L.3.0% Address:
City: State: Zip: Daytime Phone: ( )
Part II — Contractor Information (To be completed by Contractors or Homeowner, if applicable.
Name, address, & ne must match Information on license)
A. Set -Up Contractor Company Name: ¥ nd04‘ to LAC. cynautrs
Phone: 1% 31 pp Address: kilo � iP P.rcon bt.o;.S
City: 5 c¢- State: 1 - 3 `' Zip: 2'1330
Setup Signature: , • State Lic# .5 VOO
B. Electrical Contractor Company e: • flio,rrl S at cf
Phone: 479 - 3 481 Address: I t3d4 ,Slnrri R' ! "fse l i?4
City: jrC rd Slate: l Zip: ?133o
J_lectrician'a Signature: r.E4 fl O'W44.n State Liao 11 Mai- L., C. Mechanical Coidractor Company Na j: ' ?In L 5ha9 p
Phone: 1 0Q' 8 3 1 10 Address: 3`i 99 : 'cIcocrriS gel
City: •Ia"1 -g-n State: Pc- Zip: 21530
HVAC Sianature: k LA-J w Lu 0-45 bet State Licit a i 5) 3
D. Plumbing Contractor Company Name: C49+ bro • IZI
Phone: 3Sf 4
- OI(olo Address: hkkt tvs#- \rt (CA-
City: 5 al..k State: N c--# Zip: .0 330 r
Plumbers Slanaturn: -4_- (e-l- State LIc# OS�`t4
Part 111 - Manufactured Home 7
Information
Model Year: / 9'13 3 Size: /1 X ! 6 Complete & follow coning criteria sheet
Park Name: IS, r f nbfl P Lot Number: /
I hereby certify that I have the authority to apply for this permit, that the application Is correct including the contractor
Information and signatures, and that the construction or installation will conform to the applicable manufactured home
sel -up requirements, and are Harnett County Zoning Ordinance. 1 understand that If any Item Is incorrect or false
information has en proyJded that thIs permit could be revoked.
OH I N / / / /`
r e of Home Owner or Agent Date
'Effective Juy 1, 2004, a County Tax Department Moving Permit must be provided before a Set Up Permit will be issued. It is
purchased from the fax office of the county that the home la moved from. 11 the home la hum a dealer, we need proof of year on the
Form 500 and Il available, the serial number.
List of inspections and Egress requirements available upon request Progress Energy customers must provide Premise Number.
SETUP 4/08
_ V
MOZOPIALetetCrat ;' STATE ;:':.ts rit:
M R,9,,Re 5I99, CERTIFICATE OF TITLE Q73
TITLE NUMBER GROSS WEIGHT LICENSE FEE TITLE ISSUE DATE P
[772289992501115 0
VEHICLE IDENTIFICATION NUMBER:` - YEAR MODEL - MAKE BODY
OHC007439NC 1998- OXFO MI
MAILING ADDRESS'
GREEN TREE FINANCIAL SERVICING CORP
2501 BLUE RIDGE RD '
STE 200
RALEIGH NC 27607— ¢436
(5
OWNERISIJOVCE ARTIS BOTTS'
NAME AND113 PINE NEEDLES DR
ADDRESS LILLINGTON NC 27546—'8420
THIRD LIENHOLDER: DATE:
The Commissioner of
of North Carolina here!
don for a certificate oft
vehicle has been Ned pi
Lutes of North Carotins
Vehicles Ia satisfied that
owner. Ofdalrecorder
Iclea reflect vehicle Is r
S AO RELEASED aY DATE_____ herein enumerated at t
SECOND LIENHOLDER --in DATE: certificate
A. wmir_RB, his non
the day midyear upped/
tl Imue date.
COMMISSIONER C
9Mp T LIENHOLDE . DATE DATE n°`�FEo
09/07/1999 d tat{
GREEN TREE FINANCIAL SERVICING CORP, : i ifyn
2501 BLUE RIDGE RD -- STE 200
■ RALEIGH NC 27607- 6436 .'• Q , Wa ,.
1ST RELEASED BY
ADDITIONAL LIENS: d�a. ~ . " (rye
'3 t
115
w rogorcas ANTALTERATIONS ERASURES±VOID':TITLE' U
Federal and State law requires that you state the mileage in connection with the transfer of ownership. Failure to con
statement may result in fines and /or imprisonment.
ASSIGNMENT OF TITLEBY REGISTERED OWNER ? �.::.;., - +✓a*''
J a � ,ereby ytilat t v9 descrbed in this title has been transferred to th premed mama and address.
1 certify x02170 best 0 y nonledge { that the odometer reading o (NO TENTHS) and reelects the
one of the following elements Is checked'
❑ I. The mileag stated is in excess of its mechanical limo.: y )Il l l l l llgyy /, / ,
❑ 2. The odometer reading is not the actual mileage WARNING — .ODOMETER DISCRE 'i A HO , /
To my k nowledge tie vehicle dosed Air . �12 • has Ue%i3' d nos Tit
DATE VEN¢LEDEUVEnEO To C' HM¢R aacurrenCS Lathe extent that the Kitt A kI -tr exo � C71atr tt
Hand Printed Name and ` - 42e1 ' t t -. Fl • '1 iT r lit • c • .'•.
Slgnabare(s) 01 Sellat(s) . __
Ocknowledge0 ml this . a • ,A _'... r .� . 0 ' xaun a re r ;
Notary Public v. , • /�, • �' � �-- y
Tam aware of the above odometer certification and damage disclosure made by the Seller .(k
P •
Hand Printed Ner and 04)7::
ne 4 • ?
SlgmNre(q at Buyer(*) -
FIRST RE- ASSIGNMENT OF TITLE BY d'MLEril flat "
B -
J The undersigned hereby candies that the vehicle described In this titte has been translated to the following panted name and address.
Y canto to the best of my knowledge that the odometer reading is: INC TENTHS) and reflects the E
a1a oI the following statements is checked.'
0 1. The mileage stated is In excess 01 its. mechanical limits.
❑ 2. The odometer reading is not the actual mileage WARNING — ODOMETER DISCREPANCY _
To my knowledge the vehicle described herein ❑- has been ❑ has nt
031E VENOLE OEUVERED TO PURCHASER ' 000urrMC0 lO the extent hat the cost to repair exceeds 25% of lair market
Nand Printed Hama and
SIgnature(s) M dealer or agent - Dealer's Ni
Primed Firm Name - '
Acknowledged before me this day of County - -
Notary Public My Commission expires the
Tam aware at the above odometer cart!iicarron and damage disclosure made by the seller" (SEAL).
Hand Printed Name and. - - -
Slgnaturep)atBuyer(e) - •
J
PURCHASERS APPLICATION FOR NEW CERTIFICATE OF TITLE
THE UNDERSIGNED. PURCHASER OF THE VEHICLE DESCRIBED ON THE FACE OF THIS CERTIFICATE. HEREBY MANES APPLICATION FOR A NEI
TIRES THAT 5310 VEHICLE 15 SUBJECT TO THE FOLLOWING NAMED LIENS AND NONE OTHER, AND THAT THE INFORMATION CONTAINED HERE'
REST KNOWLEDGE AND BELIEF. -
' FIRST LIEN SECOND off
DATE ACCOUNT." DATE ACCOUNT
LIENHOLOER ID/ LIENHOLDER NAME LIENHOLOER IDA I.IENHOLOER NAME
ADDRESS ADDRESS
Cett
STATE • - _ ZIP CODE CITY i STATE
DISCLOSURE SECTION
In 1997, the North Carolina Legislature passed a bill which allows Wizens to protect their personal information contained in the records of the Divisic
the block below will allow the Division el Motor Vehicles to release your name and address for marketing and solicitation alter January 1, 2000.
- ❑ I (We) would like the personal Inlormatm contained in this applica
/CERTIFY FOR THE MOTOR VEHICLE DESCRIBED 0'417413 TITLE TWAT I HAVE FINANCIAL RESPONSIBILITY AS REQUIRED 1
PM, or Opt lull neap' emend company sNronxaa in N damn, orgmuP P number/ porky not Hued. name,
SIGNATURE OF PURCHASER(S) - PAW to be transferred' Odc
FIRST NAME MIDDLE NMIE LAST NAME
PAINT IN INN OR TYPE NAME EXACTLY As IT APPEARS ABOVE IN SIGNATURE D. L. Number Owner 1
ACKNOWLEDGED BEFORE ME
RESIDENCE ADDRESS THIS DAY OF
POST OFFICE COUNTY OF RESIDENCE ZIP CODE MY COMMISSION EXPIRES
MAILING ADDRESS IF DIFFERENT FROM ABOVE SIGNATURE OF NOTARY PUBLIC IN INN
NOTE: RETAIL PURCHASER MUST APPLY FOR NEW TITLE WITHIN 28 DAYS AFTER PURCHASE 0
PENALTY. ALTERATIONS OR ERASURES WILL VOID THIS TITLE. •
MYR-3 (Rev. 1/06) North Carolina Department of Transportation
DIVISION OF MOTOR VEHICLES
4 751, ; .
CERTIFICATION OF REPOSSESSION
This is to certify that the undersigned has repossessed the motor vehicle described because of the failure
of the former owner to meet his obligation in the matter of settlement of the lien described on the face of the
attached certificate of title. No suit Is now pending in court concerning this repossession. I/we hereby war-
rant tItle to this described vehicle to be free from all indebtedness and agree to defend it against all claims.
NAME OP n j/�
DEFAULTING OWNER
STREET AD U MBER *140 0 MEET OR R. .D AND BOX NUMBER)
ADDRESS OF I� Isle_ / 1 leS / )r
DEFAULTING cr I side / I a21 COUNTY
OWNER LI 1 I I Q _ l- L '
DAR OF LIEN /� DATE OF REPOSSESSION STAR ISSUED
SECURITY E g i l l 1R1 gill/ 8f i0/ l V inc
INTEREST NAGE ECU PARTY Cop
ADDRESS OF BCURED PARTY
/Slue c . e- Rd .s4z� Pate- AQ 27b07 -6y 36
MAKE YEAR/ g 0 1 0 y 1 9ERIPA YODEL
TIRE NUMBER 8 .250 1/15 I VEHICLE IDENTIFICATION 401--
Current Odometer Reading 1 I
North Carolina General Statute 20 -77(a) provides that whenever the title or interest of an owner In or to a
vehicle shall pass to another by operation of law, as upon order in bankruptcy, execution Bale, reposses-
sion upon default in performing the terms of a lease or executory sales contract, or otherwise than by vol-
untary transfer, the transferee shall secure a new certificate of title upon proper application, payment of the
fees provided by law, and presentation of the last certificate of title, If available, and such instruments or
documents of authority or certified copies thereof as may be sufficient or required by law to evidence or
effect a transfer of Interest in or to chattels in such cases.
(,ree
-11... fee A 4#ne ' J Ser✓I Gt (
��, /y/ NAME OF SWUM PARTY
BY: /( /T
Q /'� AUTHOR / nED - REPR � ESENTATIVE /�
Date: / - z7 - 1 I 0 County: t Aa.�-t State: /1 L
I certify that the following person(s) personally appeared before me this day, each acknowledging to me that he
or she voluntarily signed the foregoing document for the purpose stated therein and in the capacity indicated:
d eg - eteNU ( 94 !tic, 2,ap m r ( name(s) of principal(s).
Notary S a ......... , ' J ^ , I Lc--- J� ' 'Z
ce NUTgg y •. `s f "` `
Printed or typed nat;Ip. k � � fink- e /171 J
a : - 7 ,4O�
.7a ` ikauIG ;' V My commission expires: C
MVR -181 DAMAGE DISCLOSURE STATEMENT
(Rev. 5/01) • VEHICLES FIVE (5) YEARS OLD AND NEWER (Applies to Numbers . 1 and 4)
Alterations or erasures void this form.
•
STATE LAW REQUIRES THAT EVERY SELLER. DISCLOSE TO THE BUYER IF HE KNOWS OR REASONABLY
SHOULD KNOW, THE INFORMATION LISTED BELOW. FAILURE TO DO SO WILL RESULT IN CIVIL LIABILITY.
CA rn /991 oficvot8ciAL,
MAKE BODY STYLE YEAR MODEL VEHICLE IDENTIFICATION NUMBER
1. Has this vehicle been damaged by collision or other occurrence to the extent that damages exceed 25% of its value at the time of the y Q No
collision or other occurrence?
If yes, list parts that were damaged.
2. Was this vehicle a salvage motbr vehicle ?' (ANY Year) Yes ❑ No
It yes, in which state was it dried?
3. Is this vehicle a flood vehicle?* (ANY Year) Yes 0 No
4. Is this vehicle a recovered theft vehicle? Yes ❑ No
If yes, list pans that were damaged.
5. Has this vehicle been reconstructed ?' (ANY Year) Yes 0 No)C
I declue that the above information is true to the best of my knowledge. ACKNOWLEDGEMENT OF BUYER:
,('eel✓ Tree ( Servi Cv"jCn'
SIGNATURE OF StD.IER SIGNATURE OF BUYER
Address DEALER / OR SELLER'S
of Seller DRIVER LICENSE NUMBER
NOTICE TO BUYER: RETAIN THIS INFORMATION. STATE LAW REQUIRES YOU TO DISCLOSE, SIMILAR DAMAGE INFORMATION
WHEN YOU SELL OR TRANSFER TITLE TO THIS VEHICLE.
'See definitions on reverse side. •