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DAcuSign Envelope ID:670CADFA-1F6B-4981-BE7F-886734828A66 <br /> e <br /> SECTION 1 NATURE-Of FILING(eheckallthata10) . <br /> • ❑ New home to MHODS 0 <br /> Adding or removingaco-owner ❑ Demolition{Date: ) <br /> ® Used home sale 0 Converted.to storage <br /> ❑ Recording as peal.property <br /> • <br /> ❑ Security interest.change s 0 <br /> Removing from real property status . .0 Trip Permit <br /> ❑ Transfer by inheritance 0. Other(please note)! <br /> SECTION 2 ApPLi.CANTINFOR_MAT1=CNilease print) <br /> ®Dealer/Seller 0 Lender ❑.EscrowiTitleAgent 0 Owner/Buyer 0 Legal Representative <br /> Name: Brian L Fitterer I Phone: (503) 655-5421 <br /> (first,middle,last) <br /> Address:18006 Sky Park Circle Suite 200 <br /> city: Irvine <br /> I State: CA. j 711": 92614 <br /> Email: clairmont@ipoliving..com <br /> SECTION 3 HA'IIILE tNFORIVI ►T ON`< riforgotian:in holltis.required) <br /> Home ID#: OR No Home,IIID: ®N'ew Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer: West Ridge At 6 v e(11 <br /> Model: I Year: 2023 <br /> 2F-H-CUSTOM <br /> SerialNumber(s) HUD LabelNuniber(s)*Requiredif new home <br /> 245-000-H Al0218OA/B ORE 558938 • <br /> ORE 558939 . <br /> #of Sections: 2 Sq.footage:. 1232 Bedrooms; <br /> 3 Bathrooms:• 2 <br /> Reaiingt pe:. ,electric. Cooling.t}pe: electric <br /> ILoofingtype: Siding type: b <br /> Date of sale:(Ifppp/.��,hie) 09110f2:023 Sale price: 15,1455 Ineludes.land: • ❑Yes 12No <br /> SECTION 4 O'EALER INFOftMAT ON.(leave blank if no dealer) <br /> Name: I License#: <br /> (first,middle,last) Brian L Fitterer <br /> Address: 18006 Sky Park Circle Suite 200 <br /> City: Irvine <br /> I state:CA /AN:92614 <br /> Phone: (503) 665-5421 <br /> Email: clairmont@ipgliving.com <br /> I hereby declare this manufactured structure-is free and clear of all mortgages,deeds of trust,.security interests,and lieus.Lhave 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 1t c u 94 '' d'as.evidence in court and is subject to perjury.a'penaltyof 1/31/2024 <br /> Signature: <br /> Ait\AAJt.11.A- thA,Iyus Date: <br /> L—.7IJu5J44Nu15134ru...SECTION_S HOME LOCATION <br /> Current Address:5355 River Rd. N#7 <br /> City: Keizer 1. .Co,mty' Marion <br /> State: CA I 'Zip: 9730.3 I <br /> Park Name:(if applicable) McNary Oaks Mobile Village <br /> ❑This.is a dealer lot orstorage facility 1 <br /> 0 This home is peing..moved to a new.location Complete-0e secflon below <br /> New Address: <br /> City: <br /> I County: I State: I Zip: <br /> Park Name:(f applicable) ❑This.is:a dealer lot or:storage.facility <br /> Phone: <br /> Transporter Name: <br /> Address: 1 City: State: . <br /> IEmail: �+ lj <br /> Page12 & chI c)-el ' ,D' aJ <br /> 11.3 i' 1 1 b_,.. -1--cwr, d . 9-Q-v .__ <br /> ._ . <br /> ._ <br /> C. <br /> f 1 _as -1-Ik.n5 (Jove <br />