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tr <br /> bill 3 M . Ma; srt i*A <br /> DocuSIgn Envelope ID:39FA227C-6379-4014-A366-FBDOBE2AE2CF 4 <br /> , SECTION 1 NATURE OF FILING(check all that apply) <br /> New home to MHODS � •n weer w; � • •• • <br /> sa petty 'e�tC.Fage <br /> e real property status _ Tnp Pemdt <br /> e�it tmtce 5.1o@[hee(fllatter9vate): <br /> • <br /> SECTION 2 APPLICANT INFORMATION(please print) <br /> ❑Dealer/Seller 0 Lender ®Escrow/Title Agent ❑Owner/Buyer 0 Legal Representative <br /> FidelityName: National Title Company <br /> Pnone:503-585-7219 <br /> (first,middle,last) <br /> Address:500 Liberty St SE Ste 200 <br /> city:Salem State:OR . zrP:97301 • <br /> Email:kelly.miller@fnf.com <br /> SECTION 3 HOME INFORMATION(Information In bold is required) <br /> Home iD#: OR No Home ID: IN New Home 0 Out of state home 0 Leaving County Deed Records <br /> Manufacturer:Champion ? i 8 D- <br /> Model:West Ridge Year:2024 <br /> Serial Number(s) HUD Label Number(s)*Required If new home • <br /> • • 2450004A101668A ORE 562103 <br /> 2450004A101668B ORE 562104 <br /> • #of Sections:' 2 Sq.footage: pi S 2 Bedrooms: a_ • Bathrooms: '�.� . <br /> Roofing type: to r+d4�M Siding type: hiteire t1 Heating type: Wea-t U Cooling type: p Or- <br /> Date of sale: sq 1 Sale rice: $162,000.00 Includes land: ❑Yes IN <br /> nfaawicrwe) 3o r p <br /> SECTION 4 DEALER INFORMATION(leave blank if no dealer) <br /> Name:' License#: <br /> (first,middle,last) <br /> Address: <br /> City: State: ZIP: <br /> • <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: Date: • <br /> SECTION 5 HOME LOCATION <br /> Current Address:830 N Main St ttleZ V;.3 <br /> City:Mt Angel County:Marion State:OR Zip:97362 <br /> Park Name:(if applicable) Bavarian•Mobile Home Village ❑This is a dealer lot or storage facility <br /> ❑This home is being moved to a new location Complete the section below <br /> ��� <br /> dd>� C''fl rn CO s w /3Oid*A C <br /> City: rn/,e�le County: A,;r,/,'// State: O/t , Zip:�r <br /> • Park Name:(if applica leb ) ❑This is a dealer lot or storage facility <br /> �Transporter Name: V ffei .' [7�Te_ Phone: <br /> Address: 5 Q cW BDl fl Ref City: Pi/WA,/41//r State: Q f� <br /> Email: <br /> Page 2 <br /> • <br />