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D,h"cl Avt () L =m- --71 S ecLryi 9 —7 3 / <br /> SECTION 1 NATURE OF FILING(check all that apply) <br /> 0 New home to MHODS n t o r Q‘..Pfe abfiN ni ate: ) <br /> kl2NAIRsofeNsitts IVIZatcollayeaNcetkpOerty o� ea el-C6stbrage <br /> NjAtefiNverhtsraitiaaage NjAkeslaiorfroi r�aPpibpeRy-status ❑1 Trip Permit <br /> 'LI"1 e rjlAbonid aAsi te): <br /> SECTION 2-: �� APPLICANT INFORMATION(please print) <br /> ■❑Dealer/Seller ❑Lender 0 Escrow/Title Agent 0 Owner/Buyer 0 Legal Representative <br /> Name: <br /> (first,middle,last)COMMONWEALTH HOMEOWNER SERVICES Phone:503-244-2300 <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#: FV W OR No Home ID: ❑■ New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:SKYLINE (DI)&29 O� <br /> Model:ARLINGTON Year:2023 <br /> Serial Number(s) HUD Label Number(s) *Required if new home <br /> 245-000-H-A101450A ORE 560205 <br /> 245-000-H-A101450B ORE 560206 <br /> #of Sections: 2 Sq.footage: 1394 Bedrooms: 2 Bathrooms: 2 <br /> Roofing type: COMP Siding type: Cement Panel Heating type: ELECTRIC Cooling type: NONE <br /> Date of sale: 5-31-23 Sale price: $98,712 Includes land: ❑Yes 0 No <br /> (/f applicable) <br /> SECTION 4 ., DEALER INFORMATION(leave blank.If ►o;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: \�A�.r�"x0 Date: +�i�,,.` /013 <br /> SECTION 5 ° w , HOME LOCATION <br /> Current Address:2445 PACIFIC BLVD SW <br /> City:ALBANY County:LINN State:OR Zip:97321 <br /> Park Name: (if applicable) 0 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.#715 <br /> City:SALEM County:MARION State:OR Zip:97317 <br /> Park Name: (if applicable) SUNDIAL MHP ❑This is a dealer lot or storage facility <br /> Transporter Name:NEWMAN'S MOBILE HOME TRANSPORT Phone: 503-932-5142 <br /> Address:PO BOX 236 City: SILVERTON State: OR <br /> Email: <br /> Page 2 <br />