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<br /> AuthenUsign ID:B6DA7063-8DD7•EF11-88CF-002248299057 . /+
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<br /> ;APPLICANT INFORMATION(please.pnnt) ...a.a. s l•' . .s. . s,O`C,''�'�.:"
<br /> ❑! Dealer/Seller ❑Lender ❑Escrow/Title Agent 0 Owner/Buyer 0 Legal Representative '
<br /> Name.
<br /> 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.000K@CWRES.COM
<br /> t ,i t` HOME t N.�ORMATION{t fa ation)n bold is re iil`r a ; .� 't- „ ` ,, '"
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<br /> Home ID#:TBD N E i OR No Home ID: 0 New Home ❑Out of state home ❑Leaving County Deed Records
<br /> Manufacturer:PALM HARBOR ( 8685
<br /> Mode1:310PL15401 A Year:2025
<br /> Serial Number(s) HUD Label Number(s)*Required if new home
<br /> PHH3100R24-16236A ORE 565694
<br /> #of Sections: 1 -. Sq.footage: 704 Bedrooms: 1 Bathrooms: 1 . -
<br /> Roofing type: COMP Siding type: Lap Cement Heating type: ELECTRIC Cooling type: NONE
<br /> Sale price: $74,744 Includes land: 0 Yes No
<br /> Date of sale:
<br /> ❑
<br /> Rfapplicabk)
<br /> ; 40:07.0111# f DEALER INFCiRMAT4ON t1e ve blank tf no dkealej ` t,�,,�. ax ` ' ,-`f TM
<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: �ya�e A pT /q Date:
<br /> .'+`d 't 'F.
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<br /> Current Address:3737 PALM HARBOR DRIVE
<br /> City:MILLERSBURG County:LINN State:OR Zip:97321
<br /> Park Name:(if applicable) 0 This is a dealer lot or storage facility
<br /> 0 This home is being moved to a new location Complete the section below
<br /> New Address:4882 LANCASTER DRIVE NE,SP.#34
<br /> City:SALEM County:MARION State:OR Zip:97305.
<br /> Park Name:(if applicable) STARLITE MHP ❑This is a dealer lot or storage facility
<br /> Transporter Name:NEWMAN'S TRANSPORT Phone:503-932-5142
<br /> Address:PO BOX 236 City:SILVERTON State:OR
<br /> Email:
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