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. • <br /> NATURE OF FILINP (check ell that appliee),- <br /> rS-12-ialltfr?st n Change ownership 111:, iti e o n ition. <br /> R rdin pr a • usEI Trip permit [CI coaried-Ntorage <br /> EI Other:NEW HOME <br /> '*; - • APPLICANT INFORMATION • <br /> E] Dealer/seller El Lender 111 Escrow/title agent EI Owner/buyer El 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 <br /> Email:MELISA.COOK@CWRES.COM <br /> HOME INFORMATION. (* required) <br /> Home ID number(if known): DMV X-plate number(if known): <br /> TBD (e CO-7 D5 <br /> ri Moving in from another state <br /> Has no home ID or X-plate because: ri Coming out of county deed records <br /> ri Other: <br /> Manufacturer:SKYLINE Model:WEST RIDGE Year:2022 <br /> Manufacturer serial number BUD number <br /> 245-000-H-A101250A ORE 558891 <br /> 245-000-H-A101250B ORE 558892 <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: El Yes El No <br /> • bgALER INFORMATION (If no dealetileaile <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 /> tkki48Pcm-rtit tivoRmAttitik (if not moving, Wave,bleek) <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 />