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41.b t-- ctx\ca5 , DR <br /> .sL 4r1 3s 0 - - <br /> S11cCTION i <br /> .,.� ;.;. °.�.., ::� NJgTURF,OF,F11.44G dcheck <br /> New home to MHODS ❑ Adding or removing a co-owner ❑ Demolition(Date: <br /> El Used home sale ❑ Recording as real property ❑ Converted to storage - -- •-- <br /> ❑ Security interest change 0 Removing from real property status El Trip Permit . . . . <br /> ❑ Transfer by:inheritance 0 Other(please note): <br /> SECTION 23'. ' APPLICANT INFORMATION(please print): <br /> El Dealer/Seller 0 Lender ❑Escrow/Title Agent ❑Owner/Buyer ❑ Legal Representative <br /> :Name COMMONWEALTH HOMEOWNER SERVICES Phone 50;3-244 2300 <br /> -(first,mrddle,.last) <br /> Address:18'1'5'0 SW BOONES FERRY ROAD <br /> City.PORTLAND: State:OR. ZIP:97224 <br /> Email:MELISA.COOK@CWRES.COM <br /> SECTION 3„w . . HOME INFOR,MATIOitI-(Information In bold,is required} <br /> Home ID#: OR No Home ID: ❑■ New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:KARSTEN ( 0 L,901 <br /> Model:HEMLOCK Year:2023 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> - - ALB0428320RA <br /> ALB0428320RB <br /> #of Sections: 2- Sq.footage: 1404 Bedrooms: 3 -Bathrooms:' -2 <br /> "Roofing type: COMP- Siding type: Vertical Smagi Heating type: ELECTRIC. Cooling type NONE <br /> Date ofsale> - <br /> _._ <br /> /fQpPlicableJ <br /> 1130-23 Sale price: $1 18,210 Includes land: ❑.Yes El No <br /> SECTION`4 :DEALER,INFORMATION heave blank If no'dealer) <br /> Name COMMONWEALTH HOMEOWNER SERVICES, INC. License#:MSD508 <br /> Urst,middle,las11.. .... <br /> Address:181.500 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 Date: a 3 <br /> Current Address:2445 PACIFIC.BLVD SW <br /> City:ALBANY County:LINN State:OR Zip:97321 <br /> Park Name: (if applicable) 0 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.#358 ' <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 />