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"D--a60 La .-e R. SE ►s-n l� <br /> c�5 , �� h q C <br /> 3 <br /> SECTION 1 NATURE OF FILING(check all that apply) <br /> New hometoMHODS dcol • rei e i o er gio a tost e: <br /> )'Ye • <br /> [ ur ere�Lel a�l� ovin frc prop us- ❑® Trip Permit <br /> r by t tau eer(pleas e): <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.000K@CWRES.COM <br /> SECTION 3 ,. • HOME,INFORMATION(information in bold is required) <br /> Home ID#:TBD OR No Home ID: Q New Home ❑Out ofstate home ❑Leaving County Deed Records <br /> Manufacturer:SKYLINE COO 5O,5' <br /> Model:WEST RIDGE Year:2022 <br /> Serial Number(s) HUD Label Number(s) *Required if new home <br /> 245-000-H-A101176A ORE 558146 <br /> 245-000-H-A101176A ORE 558147 <br /> #of Sections: 2 Sq.footage: 1296 Bedrooms: 2 Bathrooms: 2 <br /> - Roofing type: COMP Siding type: Lap Cement Heating type: HEAT PUMP Cooling type: HEAT PUMP <br /> Date of sale•• 4-1-23 Sale price: $132,470 Includes land: ❑Yes ❑® No <br /> afapplicable) <br /> SECTION 4. DEALER INFORMATION(leave blank if no dealer) <br /> Name:COMMONWEALTH HOMEOWNER SERVICES, INC. License#:MSD508 <br /> (first,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:555 BOOTH BEND ROAD <br /> City:MCMINNVILLE County:YAM HILL State:OR Zip:97128 <br /> Park Name: (if applicable) LI 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.#15A <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 />