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- ate V Sci• <br /> SECTION 1:' NATURE OF FILING(check all that'apply) <br /> New home to MHODS ❑ Adding or removing a co-owner ❑ Demolition(Date:"" ) <br /> ❑ Used home sale ❑ Recording as real property ❑ Converted to storage <br /> ❑ Security interest change ❑ Removing from real property status Q Trip Permit <br /> ❑ Transfer by inheritance ❑ Other(please note): <br /> 'SECTION 2 APPLICANT INFORMATION(please print) <br /> I 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 /> SECTIONS HOME INFORMATION(Information in bold is required) <br /> Home ID# E SsA OR No Home ID: Q New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:SKYLINE (t96 6q I 1 <br /> Model:ARLINGTON Year:2023 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> 245-000-H-A101449A ORE 560202 <br /> 245-000-H-A101449B ORE 560203 <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: $99,341 Includes land: ❑Yes 0No <br /> afapplfcable) <br /> SECTION 4 DEALER INFORMATION(leave blank If no,dealer) <br /> Name: <br /> (first,middle,last)COMMONWEALTH HOMEOWNER SERVICES, INC. License#:MSD508 <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: �w,.., Date: 20 2/ :3 <br /> SECTION 5 HOME LOCATION . ,F <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 /> 0 This home is being moved to a new location Complete the section below <br /> New Address:2232 42ND AVENUE SE, SP.#716 <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 />