SET UP Application it a S
Hamett County Central Permitting
PO Box 85 Lillington, NC 27548
Telephone Number: 910 -893 -7525 Fax 910- 893 -2793 www.hamett.org/permits
Application for Manufactured Home Set -Uo Perm,/
(Please fill out each part completely)
Part I -Owner Information:
Home Owner Information (To be completed by owner of the manufactured home)
Name: l r1ete-Ca, I.J. /kin -S Address:.2z3 /h i+ �'?Gre a • Pot
City: Any .le. State:/ Zip: 0 7756/ Daytime Phone: 7$ 4 r 9- «797
Landowner Information (To be completed by landowner, If different than above)
Name: 7(dn / tAr (,nc / rl Address: /7/3 NC ,5.5 &)
City: 40-76 State: Ale Zip:77Sa4 Daytime Phone:9 , g - /610 S
Part I1- Contractor Information (To be completed by Contractors or Homeowner, If applicable.
Name, address, 8 phone myst rpetchinformalign o �yyycccenee),
A. Set -Up Contractor Company Name: Nbm s . tr.t 70 1 ' • t�
Phone: 9/9 - •-/ 9 Address: 1 61 G: tviI
City: ,' H$1l ft.,;/, tate: � ZIP: _2 t9
Setup Skinature; ,„ State Lic# 2 yll
B. Electrical Contractor Company Name: S., 7/ 2.-s _t e74 file---1
Phone: '2/96 3S-V.PZ? Address: ao/,{.j r , ,po :AI . ar
City: T State: c Zip: 7 2T ?. /
_��%
__ r: : ,_ : state Licq 2rr
C. Mechanical Contractor Co pany Name; 1. / - ...Ts 4 /i i' //t J H S rv/ �ur/�.
Phone r /.39- I/Yr/1 Address: o.` ,- .t. ,f.� J. _, —
/�1
City: i. State: /✓r Zip: .29,50/
HVAC Skrnature; State Llcl/ •
D. Plumbing Contra or Company Name: £4 (-/ cXe c 4, r¢
Phone: 7/9 l 79 5/4 7 Address: 2-0 /X0.1-•-„P / , ,;/ Ci
City: / Ste�t :' c Zip: 2. 7 /
Plumber's Sionatur ;` q / State LIc# 24' 2 8r
Part III .- Manufactured Home Information
Model Year: & Size: £j( .(o Complete & follow zoning criteria sheet
Park Name: Lot Number:
I hereby certify that I have the authority to apply for this permit, that the appllcadon Is correct Including the contractor
• information and signatures, and that the construction or Installation will conform to the applicable manufactured home
set -up requirements, and the Harney County Zoning Ordinance. I understand that If any item Is incorrect or false
information has been provided that this permit could be revoked.
a t re of Hom r//il
I gnature of Home Owner or Agent Date
'Effective July 1, 2004, a County Tax Department Moving Perm!( must be provided before a Set Up Permit 14411 be Issued. It Is
� • r • , -. • from the tax office of the county that the home is moved from. 11 the home is from a dealer, we need proof of year on the
.. If available, the serial number. • no and Egress requirements available upon request Progress Energy customers must provide Premise Number.
SETUP
4
APR -22 -2010 15:51 From:FIRST FEDERAL 8435295870 Io:717GbICUti70 I� (J�J .c''
'V.At1 1 ,c/ 1 M I CHILV L MV lk ,, TATE OF NORTH CAROLIN ?• LyVI_'t IV 7i r ')/.:•'t`.
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CERTTFLCATE OF TITLE I '�
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' ., VEHICLE IDENTIFICATION.NUM H ER YEAR MODEL MAKE BODY STYLE '
H4011B6GLR 2006 HORT MH I )
I I9T4E NUMAP.R AT TITLE? ISSUE DE PRRVIOUS'riTl.r; NUMBER
774929053322909 11/30/2005 776737052974909 l'(':
S 1uhllrlfldllloLIIJLLILII „1,111,IrrI1JL,ItrItJ ,•11 ° ° P.0 uMIPI NlA9i$C
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' o FIRST FEDERAL I+Ea'''''; '
t PO BOX 118068 OI,OMNTILN tl'IA'YUN I ;
I, CHARLESTON SC 29423-0068
i i0 / TI'I'IJt IIIIA ?
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i ,. t (WNFRI$) NAME ANO ADDRESS I ,
' I JOAN L KLING I l
: >1 6671 WRIGHT RD LOT 12
,• r THOMASVILLE : NC 27560.8397 I
I DIII IUIIIII I11II!H IIIa Ih IIIII IIII IIlI IIIII IIII III IIIII IIII IIl flI
p1 '11te CnmminiunerufMotor Whiele of the Sink: nf North Carolina hereby emnlicn that an application In, ii cnifluiie of title for lbv harcin Aa,eriMA
9, ?
g1 : ham boon 111eA pamunntln the General Statute. ter North Carolina nud biped on that application, Ihe'Div nfon „I'Mninr Vchiela ia wfiiliod Ihhl the nppliaLim H✓
j i, ilia idwIlil nwmar. Olileial record' of the Oivivlim of Motor Vehicle tofoct while b vuhjecl lo the boom. f inny, herein onamormad ur J+e dblu of iviuonee I
I of this vcnl0cma (
Al I L NE95, his band and seal of thus Division of the Aay and year apnerinOIn d,iii ronilicnro nd tho Udo Imo dote. I
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I I C IONER FMO'ftR VHIiICI.Ii$
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I RIRST LIONHQLDER: DATE OF LIEN 10/07/2005 '
,, -, FIRST FEDERAL - URN RELEASED j ' ,)
• PO BOX 110068 SIONATURI +.
' CHARLESTON SC 294 TITIF . 1)&11 '
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SECOND LII ?NtIOLDHR• OA'I "F OP ' LIEN `j'
l r: r u LIEN RELEASED 9Y: 1
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ii y TITLE DA1ll I
IS' 4 I
I THIRD'LIRNHOI DI ?H. DATE 0I' LIEN ly ), LIEN RI:LEASIIU HY: ti{
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{ l i 'i ritr ,. • DATE f
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• ( , FOURTH . LreN1 .. DATP. OF LIEN
LIEN RELEASED BY:
' � � 91DNATURH
fi1Lll - DATO.....
I't :i 80475093 , i
ADDITIONAL LIENS:
, ^ /`.; — — 909 0 T1M BIJ F
iIaI` I-. A It -L/\ f ,; i! ANY ALTERATIONS OR ERASURES VOID TITLE \-% �iii," i A . -, �i~-+A�:.-4AF ..
EAGLE HOMES
3600 US 70 HWY EAST
SMITHFIELD, NORTH CAROLINA 27577
. PHONE: 919- 202 -0400 FAX: 919- 202.0495
RECEIVEDIFRO ^M/M 6'.5� //J� w� //�� I p / /A, 5 A`/ ! DATE
ADDRESS !/21 3 `� l / Gig ad 124 / 1/a t.,
DEPOSITOR YEAR MAKE SERIALM
HOME
;CM filch r✓ I YO /1 qj
COMMENTS OR DESCRIPTION IF OTHER THAN A DEPOSIT ON A HOME CHECK HOW PAID
CK
" t /O CH " E `'4 I-U77 AM UNT R CASH ,4*.e, mhed_79—*
AMOUNT RECEIVED
RECEIVED BY /�
- D.
/
SUMMIT HOMES OF NC, INC.
D /B /A EAGLE HOMES
3600 US 70 Highway E •
Smithfield, North Carolina 27577
(919) 202-0400 • Fax: (919) 202.0495
BUYS HOME PHONE CELL PHONE DATE
JO WELDON WILKINS 8 JOSEPH ASHLEY WILKINS (919) 639-4847 (919) 809 -0504 Aug 12, 2010
2 583 OAK GROVE ROAD A STATE 2 EMAIL
DELIVERY ADDRESS CITY STATE ZIP SALESPERSON
25 OAK GROVE ROAD ANGIER NC 27501 SCOTT JONES
MAKE MODEL STOCK NUMBER SERIAL NUMBER
THIS UNIT 19 USED HORTON ECHO N/A H401186GLSR
YEAR BEDROOMS BATHS FLOOR SIZE HITCH SIZE COLOR KEY NUMBERS PROPOSED DELIVERY DATE
2006 3 2 ,L 56 Iw 24 L 60 lo 24 GRAY /BLACK NIA AS AGREED
LOCATION R.VALUE THICKNESS TYPE OF INSULATION BASE PRICE OF UNIT $ 28,250.00
, CEILING N/A OPTIONAL EQUIPMENT __0.00_
EXTERIOR N/A ,
FLOORS N/A SUB -TOTAL $ 28,250.00
THIS INSULATION INFORMATION WAS FURNISHED BY THE MANUFACTURER AND _
IS DISCLOSED IN COMPLIANCE WITH THE FEDERAL TRADE COMMISSION RULE SALES TAX
t BCFR SECTION 46Q. 16.
OPTIONAL EQUIPMENT, LABOR AND ACCESSORIES NON - TAXABLE ITEMS
PRICE OF HOME INCLUDES DEUVERY AND SET UP TO $ VARIOUS FEES AND INSURANCE
THE ABOVE DELIVERY ADDRESS - BLOCKING. LEVELING. CASH PURCHASE PRICE $ 28,250.00
ANCHORING AND TIE DOWNS TRADE -IN ALLOWANCE $ „: # ;! # '/ ' %% ��
LESS BALANCE DUE on above $ 0.00 .i ' / -', '!
PRICE OF HOME ALSO INCLUDES TRIM OUT OF INTERIOR NET ALLOWANCE $ 0.00 %% /�',j:
AND EXTERIOR CASH DOWN PAYMENT $ 28,250.00 ? /j�,! , / %!i”,
_ CASH AS AGREED $ ' V//0 /,; :."0",
LESS TOTAL CREDITS $ -28,250.00_
BUYERS ARE AWARE THAT THE HOME IS SOLD AS-IS SUB -TOTAL $ 0.00
WHERE IS EXCEPT FOR ABOVE MENTIONED OPTIONS SALES TAX (D Not Included Above)
Unpaid Balance of Cash Sale Price $ 0.00
BUYERS ALSO ACKNOWLEDGE THAT THIS IS A REPO Dealer and Buyer certify that the additional terms and
HOME SOLD BY EAGLE HOMES FOR FIRST FEDERAL conditions printed on the other side of this Agreement are
SAVING OF CHARLESTON, S.C. AND THERE IS NO agreed to as a part of this Agreement, the same as if printed
WARRANTY EITHER EXPRESSED OR IMPLIED BY EAGLE
above the signatures. Buyer is purchasing the above
described manufactured home; the optional equipment and
HOMES. accessories, the Insurance as descAbed has been voluntary;
that Buyer's tradean is free from all claims whatsoever, except
as noted.
ESTIMATED RATE OF FINANCING %
NUMBER OF YEARS
ESTIMATED MONTHLY PAYMENTS $
THIS AGREEMENT CONTAINS THE ENTIRE UNDERSTANDING
BETWEEN DEALER AND BUYER AND NO OTHER REPRESENTATION OR
INDUCEMENT, VERBAL OR WRITTEN, HAS BEEN MADE WHICH IS
NOT COVERED IN THIS AGREEMENT.
BUYER(S) ACKNOWLEDGE RECEIPT OF A COPY OF THIS ORDER MD THAT
BUYER(S) WLVE READ AND UNDERSTAND THE BACK OF THIS AGREEMENT.
I UNDERSTAND THAT 1 HAVE THE RIGHT TO CANCEL
THIS PURCHASE BEFORE MIDNIGHT OF THE THIRD
BIANCE CARRIED TOOPTONALEQUIPMENT 0.00 BUSINESS DAY AFTER THE DATE THAT I HAVE
N0TE: WARRAN1YAND EXCLUSIONS AND L.MTAf)ONS or DAAVCES ON THE REVERSE SIDE, SIGNED THIS AGREEMENT. I UNDERSTAND THAT THIS
OESLITIPTKIN OF TMDNN YEAR SIZE CANCELLATION MUST BE IN WRITING. IF I CANCEL
fV/A a THE PURCHASE AFTER THE THREE DAY PERIOD, I
MAKE
L I MODEL sE°HOOMS UNDERSTAND THAT THE DEALER MAY NOT HAVE
TITLE NO. SERIAL NO, co&.o ANY OBLIGATION TO GIVE ME BACK ALL OF THE
MONEY THAT I PAID THE DEALER. I UNDERSTAND
AMOUNT TO ANY ANY CHANGE TO THE TERMS OF THE PURCHASE
OWING
AGREEMENT BY THE DEALER WILL CANCEL THIS
ANY DEBT BUYER OWES ON TRADE -IN IS TO BE PAID BY - AGREEMENT 4 , I q
SUMMIT HOMES OF NC, INC. O / i /1 FAMES
F D/B /A EAGLE HOMES DEALER SIGNEDX '
Na W/d Unless • • .. .A.... by en Officer of Ms CanCeM' Oren AUPMTedA9ea
Approved BY /' � � SIGNED x SUPER
FORM 50; A ELECTRONIC VERSION A PLAIN LANGUAGE PURCHASE AGREEMENT Coppgm 01983 JENKINS BUSINESS FORMS •600.851 < +91 Rev 5309
G/