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2-aOi) ca ,e y D . SE 6ISi q7817 <br /> NATfJR is FILIN ..(check all that pplies} <br /> cudJry' rest ❑ Change ownership t n at 1't• n: <br /> e din r al pro t m Ing o •a pet t• ri i Co e e s are <br /> 0 Other:NEW_HOME. <br /> APPLICANT INFORMATION, <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 <br /> Email:MELISA.COOK@CWRES.COM <br /> r '` H.1 ,4E INFO ACTION-(' recj airedj. <br /> 1-lome ID number(if known): DMV X-plate number(if known): tt�� <br /> TBD 00 (6-1RS <br /> Ti Moving in from another state <br /> Has no home ID or X-plate because: Ti Coming out of county deed records <br /> r Other: <br /> Manufacturer:SKYLINE Model:WEST RIDGE Year:2022 <br /> • Manufacturer serial number HUD 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: ❑ Yes [®1 No <br /> A{ A ► fplinMATION (If no deaI1:r,leave 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 /> ' QRTER INFORAIVOION (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 />