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Authentisign ID:5B4F77B9-60C9-EF11-88CF-002248299057 ea. 3 P ar Ave v` SE ( { (/V A i s (,4{•�!m 9.131 , <br /> SECTION 1 .` � NATURE OF FILING(check all.that apply) <br /> ❑■ New home to MHODS 'ng a er dllt( te: <br /> V\etsa ota-ale 12'teeiNdirtigynertaLtrwerty EncteatesLterstorage <br /> c .riltr�t c e e n status M Trip Permit <br /> t t ce ote): <br /> SECTION 2 r;E , :, APPLICANT INFORMATION (plea'se print) <br /> ❑■ Dealer/Seller ❑Lender ❑Escrow/Title Agent El Owner/Buyer ❑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 • HOME INFORMATION (information in bold is required) <br /> Home ID#: OR No Home ID: ❑New Home El Out of state home ❑Leaving County Deed Records <br /> Manufacturer:CMH MANUFACTURING WEST 06 .1 I <br /> Mode1:72DRM28523AH24 Year:2024 ! <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> ALB0436370RA ORE 564966 <br /> ALB043637ORB ORE 564967 <br /> #of Sections: 2 Sq.footage: 1404 Bedrooms: 3 Bathrooms: 2 <br /> Roofing type: COMP Siding type: LAP CEMENT Heating type: ELECTRIC Cooling type: NONE <br /> Date of sale: 1-2-25 Sale price: $136,639 Includes land: ❑Yes Ll No <br /> aljapplicable) <br /> SECTION 4°- DEALER INFORMATION(leave blank if no dealer) <br /> Name: License#: <br /> Urst,middle,last) <br /> Address: <br /> City: State: ZIP: <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,L'OCATION <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 /> El This home is being moved to a new location Complete the section below <br /> New Address:2232 42ND AVENUE SE,SP.#900A <br /> City:SALEM County:MARION State:OR Zip:97317 <br /> Park Name: (if applicable) 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:SILVERTON State:OR <br /> Email: <br /> Page 2 <br />