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o Laney --er R SE, 0 <br /> �-a o t5 -7 ,S akm 9 -7 3/I <br /> SECTION 1 NATURE OF FILING(check all that apply) <br /> N New home to MHODS in r o ' a - r e i' n(eate: ) <br /> EAJA 3'VerfiSe'a of ' s t I o rty er c, crNterage <br /> IlYNeatilleParlfee o r e us Q Trip Permit <br /> is a • i e 0 p srrnole): <br /> SECTION 2 APPLICANT INFORMATION(please print) <br /> El 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 botd is required) <br /> Home ID#: E OR No Home ID: I New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:SKYLINE 100 O cl! `l <br /> Model:ARLINGTON Year:2023 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> 245-000-H-A101453A ORE 560220 <br /> 245-000-H-A101453B ORE 560221 <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: $94,723 Includes land: ❑Yes 0 No <br /> (If applicable) <br /> SECTION 4 ..: DEALER INFORMATION(leave blank if no dealer) . <br /> Name:COMMONWEALTH HOMEOWNER SERVICES, INC. License#:MSD508 <br /> (first,middle,las() <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: C\r„t5 q, ( Date: 0.,fil d-3 <br /> 'SECTION 5 : HOME'LOCATION <br /> Current Address:2445 PACIFIC BLVD SW <br /> City:ALBANY County:LINN State:OR Zip:97321 <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. #27 <br /> City:SALEM County:MARION State:OR Zip:97317 <br /> Park Name: (f 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 />