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Ct, Inn <br /> SECTION'. NATURE OF FILING(check all that apply) <br /> ❑i New home to MHODS din re - n <br /> N.Als 1-11 lea r ' re nv e to s <br /> Seottct..i.atetest cl a ge vin rea r status Q Trip Permit <br /> er inheritance ❑ Ot r(e�p Perse note): <br /> SECTION'2. APPLICANT INFORMATION (please print) <br /> ©Dealer/Seller ❑Lender ❑Escrow/Title Agent ❑Owner/Buyer ❑Legal Representative • . <br /> Name:COMMONWEALTH HOMEOWNER SERVICES Phone:503-244-2300 <br /> (first•middle,last) <br /> Address:18150 SW BOONES FERRY ROAD • <br /> City:PORTLAND State:OR ZIP:97227 <br /> Email:MELISA.COOK@CWRES.COM <br /> SECTION 3 HOME INFORMATION (information in bold is required) <br /> Home ID#:TBD OR No Home ID: Q New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:FLEETWOOD Ca ni CO 5 Ui, <br /> Model:EAGLE . Year:2022 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> FLE2100R22-22299A ORE 558217 <br /> FLE2100R22-22299A ORE 558218 <br /> #of Sections: 2 Sq.footage: 1296 Bedrooms: 3 Bathrooms: 2 .. • <br /> Roofing type:. COMP Siding type: Lap Cement d Heating type: HEAT PUMP Cooling type: HEAT PUMP <br /> Date of sale: 4-1-23 Sale price: $108,155 Includes land: ❑Yes El No <br /> (If applicable) <br /> SECTION 4 DEALER INFORMATION(leave blank if no dealer) <br /> Name:COMMONWEALTH HOMEOWNER SERVICES, INC. License#:MSD508 <br /> (irst,middle,last) <br /> Address:18150 SW BOONES FERRY ROAD <br /> City:PORTLAND State:OR ZIP:97224 <br /> Email: - Phone: <br /> I hereby declare 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 or my interest in it. The information listed is true to the best of my knowledge and <br /> belief,and I understand it can be used as evidence in court and is subject to a penalty of perjury. <br /> Signature: Date: <br /> SECTION 5 . HOME LOCATION <br /> Current Address:2655 PROGRESS WAY <br /> City:WOODBURN County:MARION State:OR Zip:97071 <br /> Park Name: (if applicable) ['This is a dealer lot or storage facility <br /> ❑This home is being moved to a new location Complete the section below <br /> New Address:2200 LANCASTER DRIVE SE, SP. #17A <br /> City:SALEM County:MARION State:OR Zip:97301 <br /> Park Name: (if applicable) SUNDIAL MHP ❑This is a dealer lot or storage facility <br /> Transporter Name: Phone: <br /> Address: City: State: <br /> Email: <br /> Page 2 <br />