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3D, 4 D," • <br /> ve SE <br /> SECTION 1 NATURE OF FILING(check all that apply) <br /> ® New home to MHODS _majalin r [ 0efrl�,tl'G'Pb4141ate: <br /> EIAMeliNianharkile storage <br /> aNgleirytteilotthange a Sr erty'sflt tus © Trip Permit <br /> aYrksf6Nlyiniaariauce note): <br /> SECTION 2 APPLICANT INFORMATION(please print) <br /> Dealer/Seller ❑Lender 0 Escrow/Title Agent 0 Owner/Buyer 0 Legal Representative <br /> Name:COMMONWEALTH HOMEOWNER SERVICES Phone:503-244-2300 <br /> Urst,middle,last) <br /> Address:18150 SW BOONES FERRY ROAD <br /> City:PORTLAND State:OR ZIP:97224 <br /> Email:MELISA.COOK@CWRES.COM <br /> SECTION 3 HOME INFORMATION (Information in bold is required) . <br /> Home ID#:TBD OR No Home ID: IN New Home 0 Out of state home ❑Leaving County Deed Records. <br /> Manufacturer:CLAYTON ( O`7 3 ( q <br /> Model:72DRM28523AH23 Year:2023 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> ALB0426720RA NTA 2182345 <br /> ALB0426720RB NTA 2182346 <br /> #of Sections: •2 Sq.footage: 1404 Bedrooms: 3 Bathrooms: 2 <br /> Roofing type: COMP Siding type: Vertical Demo Heating type: ELECTRIC Cooling type: NONE <br /> Date of sale. 9-15-23 Sale price: $132,000 Includes land: ❑Yes No <br /> armaicable) <br /> SECTION 4 DEALER INFORMATION(leave blink If no dealer). <br /> Name:COMMONWEALTH HOMEOWNER SERVICES, INC. License it:MSD508 <br /> 67rst,middle,last) <br /> Address:18150 SW BOONES FERRY ROAD <br /> City:PORTLAND State:OR ZIP:97224 <br /> Email: ^ A9 Phone: <br /> I hereby declare this manufactured structure is free and clear of all mortgages,deeds of trust,security interests,and liens.1 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: <br /> SECTION 5 HOME LOCATION <br /> Current Address:2445 PACIFIC BLVD SW <br /> City:ALBANY County:LINN State:OR Zip:97321 <br /> Park Name:Of 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:2232 42ND AVENUE SE, SP.#110 <br /> City:SALEM County:MARION State:OR Zip:97317 <br /> Park Name:of 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 />