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o o a corn ca_sLr -DR 8 E 36 <br /> SECTION 1 ,,•, :. .' '' NATURE OF I=ILING(check all fhat apply) . <br /> ❑� New home to MHODS ❑ Adding or removing a co-owner ❑ Demolition(Date: J <br /> - ❑ Used home sale ❑ Recording as real property ❑ Converted to storage - - ._ Security. ❑ Security interest change ❑. Removing from real property status El Trip Permit <br /> ❑ Transfer by`inheritance ❑ Other(please note): ; <br /> INFORMATION(please print) <br /> -, a Dealer/Seller ❑Lender ❑Escrow/Title Agent ❑Owner/Buyer ❑Legal Representative _ <br /> Narrie COMMONWEALTH HOMEOWNER SERVICES Phone 503'-244 2300 <br /> ors[.middle.last) <br /> Address::18150 SW BOONES FERRY ROAD . <br /> City::PORTLAND State:OR ZIP:.97224 <br /> Email:MELISA.COOK@CWRES.COM <br /> SEICTION 3 t 't ,.° HOME INFORM, ATION,(Information'in boldIs required). {; s :: <br /> Home ID#:.NE OR No Home ID: ❑■ New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:CLAYTON (Q (T—00 <br /> Model:72DRM20482AH23 Year:2023 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> ALB0428290RA NTA 2197790 <br /> ALB042829ORB NTA 2197791. <br /> #of Sections:: 2 Sq.footage: .1040 Bedrooms:' 2 ;Bathrooms 2 <br /> Roofing type:- COMP"" .. Siding type: Vertical Small Heating type: ELECTRIC Cooling-type: E':NON <br /> Date of sale: <br /> (If applicable) 11-30-23 Sale price $101,734 Includes land: ❑Yes IDNo <br /> <i S:ECTION A,, DEALER INRORMATIONleave <br /> ".... Name: . - . . . <br /> (first,middle,last)COMMONWEALTH HOMEOWNER SERVICES, INC. License#:MSD508 <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`t Date: 1a-/ t I,a1.3 <br /> SECTION, :' ', . . HOMEryIOCATION„ : . <br /> " <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.#30 <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 />