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4 a, , , ., NATURE f F FILING:(check-all thatppliea), <br /> ❑ Change security interest ❑ Change ownership ❑ Demolition Date of demolition: <br /> ❑ Recording as real property ❑Removing from real property status 0 Trip permit ❑ Converted to storage <br /> ❑■ Other:NEW HOME <br /> `` APPLICANT INFORMAATION <br /> ❑i 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 /> HOME •,INFORMATION egiuoretl)' <br /> Home ID number(if known): DMV X-plate number(if known): <br /> TBD VOCJ 7c3_7 <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:2023 <br /> Manufacturer serial number HUD number <br /> 245-000-H-A101481A ORE 560572 <br /> 245-000-H-A101481B ORE 560573 <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:1-25-23 *Sales price:$145,735 *Includes land: ❑Yes Ej No <br /> ` k DEALER INFORMATION'(if no dealer,heave bla*i <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 net moving,::leave Wall() <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 />