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1 /-.ancia_s-L7 <br /> � Rs � 35 .9 <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 ❑■ Trip Permit <br /> 0 Transfer by inheritance ❑ Other(please note): <br /> SECTION Z 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.COOK@CWRES.COM <br /> SECTION 3 5 HOME;INFORMATION(Information in bold is required) <br /> Home ID#: E Vj OR No Home ID: ❑i New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:CLAYTON b la 9© D-- <br /> Model:72DRM28523AH23 Year:2023 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> ALB0427600RA NTA 2191060 <br /> ALB042760ORB NTA 2191061 <br /> #of Sections: 2 Sq.footage: 1404 Bedrooms: 3 Bathrooms: 2 <br /> Roofing type: COMP Siding type: Cement Panel Heating type: ELECTRIC Cooling type: NONE <br /> Date of sale: 8-28-23 Sale price: $97,162 Includes land: ❑Yes ❑� No <br /> (!./'applicable) <br /> SECTION 4..: DEALER INFORMATION(leave blank if no dealer) <br /> License#:MS Name:COMMONWEALTH HOMEOWNER SERVICES, INC. <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: ' `,t'\&Ah a� \.(; ( Date: 1 /0)3 <br /> SECTION _ k' �' ` .HOME LOCATION <br /> Current Address:2445 PACIFIC BLVD SW <br /> City:ALBANY County:LINN State:OR Zip:97321 <br /> Park Name:(if applicable) El 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:2410 LANCASTER DRIVE SE, SP.#359 <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 />