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3 ScLmc <br /> SECTION 1. NATURE OF FILING(check all that apply) _ <br /> • New home to Ml-IODS ❑ 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 Trip Permit <br /> ❑ Transfer by inheritance ❑ Other(please note): <br /> SECTION 2 APPLICANT INFORMATION(please:print) <br /> Q Dealer/Seller 0 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 bold Is required) <br /> Home ID#: 1 kil OR No Home ID: 0 New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:CLAYTON 6 ,P-8 <br /> Model:72DRM20482AH23 Year:2023 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> ALB0425660RA NTA 2171224 <br /> ALB042566ORB NTA 2171225 <br /> #of Sections: 2 Sq.footage: 880 Bedrooms: 2 Bathrooms: 2 <br /> Roofing type: COMP Siding type: Vertical Cemo Heating type: ELECTRIC Cooling type: NONE <br /> Date of sale: 6-1-23 Sale price: $82,686 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,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: <midy <br /> ECTION 5 <br /> .�° . .:� : . _ °� �;�. �e � , ; _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:2200 LANCASTER DRIVE SE, SP.#3A <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 />