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cg- off. OD 2. canCr. S V Dr. SE, <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 El Trip Permit <br /> ❑ Transfer by inheritance ❑ Other(please note): <br /> SECTION 2 - APPLICANT INFOR MATION(please print) f <br /> 0 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:P.ORTLAND State:OR ZIP:97224 . . .. . <br /> Email:MELISA.COOK@CWRES.COM <br /> —SECTION 3 HOME INFORMATION (Information In bold is required) <br /> Home ID#: E OR No Home ID: Q New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:CLAYTON 61.0(09 1 v <br /> Model:72DRM28523AH23 Year:2023 _, , <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> ALB0428280RA NTA 2197788 <br /> ALB042828ORB NTA 2197789 <br /> #of Sections: 2 Sq.footage: 1350 Bedrooms: 3 Bathrooms: '2 <br /> Roofing type: COMP Siding type: Vertical Small! Heating type: ELECTRIC -. Cooling type: NONE ' <br /> Date of sale: 11-30-23 Sale price: $113 972 Includes land: ❑Yes El No <br /> (If applicable.) <br /> SEC-TION,4 • DEALER INFORMATION(leave blank Ifni dealer) <br /> License#:MSD508 <br /> 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 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: Ccoci\s., Date: l,, a / a,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.#26 <br /> City:SALEM County:MARION State:OR Zip:97317 <br /> Park Name: (if applicable) SUNDIAL MHC ❑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 />