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c?-a 3 , 501 S c,l,orn, <br /> SECTION 1 - NATURE OF FILING(check all that apply) <br /> ! F e � t�i�,f�4bff�LlA i g co er e liti <br /> - a ale co s, a p rty VAC ii • age <br /> Se rfy ititey t c e R -to ' g real el s ❑® Trip Permit • <br /> isfark in e t IZI/Gfret-fpleuse note): <br /> SECTION 2 APPLICANT INFORMATION(please print) - <br /> Li 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.000K©CWRES.COM <br /> SECTION 3 HOME INFORMATION(information in bold is required) <br /> Home ID#:TBD W OR No Home ID: Q New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:FLEETWOOD CPO &507- <br /> Model:EAGLE Year:2022 <br /> Serial Number(s) HUD Label Number(s) *Required if new home <br /> FLE2100R22-22296A ORE 558213 <br /> FLE2100R22-22296B ORE 558214 <br /> #of Sections: 2 Sq.footage: 1296 Bedrooms: 3 Bathrooms: 2 <br /> Roofing type: COMP Siding type: Lap cement in Heating type: HEAT PUMP Cooling type: HEAT PUMP <br /> Date of sale: Sale price: Includes land: ❑Yes Ef No <br /> (If applicable) <br /> SECTION ,; ;DEALER INFORMATION(leave blank if no-dealer) <br /> Name:COMMONWEALTH HOMEOWNER SERVICES, INC. License#:MSD508 <br /> irsl,middle, last) <br /> Address:18150 SW BOONES FERRY ROAD <br /> City:PORTLAND 1 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 `• , V ��.0 Date: /7 cl 4- <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:2232 42ND AVENUE SE, SP.#504 _ <br /> City:SALEM County:MARION State:OR I Zip:97317 <br /> Park Name: (if applicable) SUNDIAL MHP sun T.vvc c c ❑This is a dealer lot or storage facility <br /> Transporter Name:NEWMANS MOBILE HOME TRANSPORT Phone: <br /> Address: PO BOX 236 City: SILVERTON State: OR <br /> Email: <br /> Page 2 <br />