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DAlb j_savAccist-cy OR S 360 Sa,lerY-) 9731 -7 <br /> SECTION 1 NATURE OF FILING(check all that apply)" , <br /> Q New home to MHODS m r er kl/P'b1 to >Sh-(late: <br /> \ th pn ersale 'Nil- Reed d�yCtg 'r'eaPpiaperty Kl...,C i'tee o torage <br /> ' tcity.inte esr ange e • r tatus 0 Trip Permit <br /> NO.,17saRsfekt5pttyl}ertlknce re): <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 /> Ors!,middle last <br /> Address: <br /> 18150 SW BOONES FERRY ROAD <br /> City:PORTLAND State:OR ZIP:97224 <br /> Email:MELISA.COOK@CWRES.COM <br /> SECTION 3�_ti HOME INFORMATION(information in bold is required) <br /> Home ID#: t V v OR No Home ID: 0 New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:KARSTEN (.00(9q O� <br /> Model:72IKC28483CH23 Year:2023 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> ALB0429670RA NTA 2210890 <br /> ALB0429670R$B NTA 2210891 <br /> #of Sections: 2 Sq.footage: 1296 Bedrooms: 3 Bathrooms: 2 <br /> Roofing type: COMP Siding type: Vertical Small Heating type: ELECTRIC Cooling type: NONE <br /> Date of sale 12-28-23 Sale price: $1 18,827 Includes land: ❑Yes 0 No <br /> (Ifapplicable) <br /> SECTION 4 F DEALER INFORMATION(leave blank If no dealer) <br /> Name:COMMONWEALTH HOMEOWNER SERVICES, INC. License#:MSD508 <br /> (lirsl,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: .j� CAS_ Date: \-�,.. 2,4 <br /> ,SECTION'S," 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:2410 LANCASTER DRIVE SE, SP. #360 <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 />