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SECTION 1 NATURE OF FILING(check all that apply) <br /> El New home to MHODS g wner [y7eua64ttiatr(Date: ) <br /> se i s ierty et•c-**-1-d-trrgrrsrage <br /> inztistlslaatIge pi e y status El Trip Permit <br /> b en a 1:3,Dttrgrigray.mote): <br /> SECTION 2 . 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:97224 <br /> Email:MELISA.COOK@CWRES.COM <br /> HOME INFORMATION(Information.In bold is required)SECTION 3 �:,� � ;" <br /> Home ID#:TBD OR No Home ID: El New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:CLAYTON It! O ( /Olt <br /> Model:72DRM28523AH23 Year:2023 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> ALB0426880RA NTA 2182380 - - <br /> ALB0426880RB NTA 2182381 <br /> #of Sections: 2 Sq.footage: 1404 Bedrooms: 3 Bathrooms: 2 -" <br /> Roofing type: COMP Siding type: Vertical Cemu Heating type: ELECTRIC Cooling type: NONE <br /> Date of sale: 9.11-23 Sale price: $115,052 Includes land: ❑Yes 0 No <br /> afapphcable) <br /> SECTION 4 P. DEALER,INFORMATION(leave blank I` rfno dialer).. <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: c c1/4. IS‘ <br /> Date: <br /> SECTION 5 a "`".�. .: 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 /> ❑a This home is being moved to a new location Complete the section below <br /> New Address:2410 LANCASTER DRIVE SE, SP.#361 <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 />