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-a6 R. sL 31. <br /> l7 <br /> NATURE QF FILING (check all thatapplies) ;<-g <br /> •a c ' rest ElChange ownership o em io <br /> o g•a al e e vi g r pe at • ei t ve or e <br /> Q Other:NEW HOME <br /> APPLICANT <br /> ❑® Dealer/seller ❑ Lender ❑ Escrow/title agent ❑ Owner/buyer ❑ Legal representative <br /> Name:COMMONWEALTH HOMEOWNER SERVICES <br /> Address(including city,state,and ZIP):18150 SW BOONES FERRY ROAD, PORTLAND, OR 97224 <br /> Phone:503-244-2300 Email:MELISA.COOK@CWRES.COM <br /> HOME INFORMATION (* required) <br /> Home,ID number(if known): DMV X-plate number(if known): <br /> TBD 4206 71- <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:SKYLINE Model:WEST RIDGE Year:2022 <br /> Manufacturer serial number HUD number <br /> 245-000-H-A101255A ORE 558899 <br /> 245-000-H-A101255B ORE 558900 <br /> • <br /> *Number of sections:2 *Square footage: 1344 *Number of bedrooms:2 *Number of bathrooms:2 <br /> *Type of roofing:COMP *Type of siding:HARDIBOARD *Heating:HEAT PUMP *Cooling:HEAT PUMP <br /> *Date of sale:1-6-23 *Sales price:$145,735 *Includes land: ❑ Yes 0 No <br /> blank} <br /> Dealer name: Dealer license number: Dealer address and phone: <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): Dealer signature: Date: <br /> TRANSPORTER INFORMATION (if not moving., Leave blank} <br /> Transporter name: Transporter address and phone: <br /> Newman's Mobile Home Transport PO Box 236 <br /> Silverton, OR 97381 <br /> 503-932-5142 <br /> 440-2952(7/17/COM) Page 2 <br />