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qt. <br /> o anca.6-1--ev R- Sf, °L9 <br /> SECTION 1 „ NATURE OrFILINO(Check all that aPPIY) - • ' - <br /> „ <br /> ji New home to MHODS 0 Adding or removing a co-owner El Demolition(Date: <br /> El Used home sale 0 Recording as real property 111 Converted to storage - <br /> 0 Security interest change 0 Removing from real property status Trip Permit <br /> 0 Transfer by inheritance I 0 Other(please note): <br /> SECTION 2 APPLICANT INFORMATION (please print) <br /> Ej Dealer/Seller El Lender 0 Escrow/Title Agent 0 Owner/Buyer 0 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 /> SECTION 3 tiONIE,INFORMATIONIAlrifOrmation in bold is required). -` , • • <br /> Home ID#: Ev\f OR No Home ID: New Home ri Out of state home ill Leaving County Deed Records <br /> Manufacturer:FLEETWOOD (0 0 <br /> Model:EAGLE. Year:2024 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> FLE2100R23-23596A ORE 562614 <br /> FLE2100R23-23596B ORE 562615 <br /> #of Sections: 2 Sq.footage: 1404 Bedrooms: 3 Bathrooms: 2 . <br /> Roofing type: COMP Siding type: Vertical Smagt Heating type: ELECTRIC Cooling type: NON <br /> Date of sale: 11-30-23 Sale price: $110,969 Includes land: 0Yes [Ij No <br /> SECTION 4 ' DEALER INFORMATION(leave blank if no dealer) <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: • QAzkt_ Date: <br /> SECTION 5' 7 , NOME,LO,CATION <br /> Current Address:2655 PROGRESS WAY <br /> City:WOODBURN County:MARION State:OR Zip:97071 <br /> Park Name: (if applicable) FLEETWOOD HOMES El This is a dealer lot or storage facility <br /> El This home is being moved to a new location Complete the section below <br /> New Address:2200 LANCASTER DRIVE SE, SP.#29 <br /> City:SALEM County:MARION State:OR Zip:97317 <br /> Park Name: (ff applicable) SUNDIAL MHC El 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: SI LVERTON State: OR <br /> Email: <br /> Page 2 <br />