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t-7 q44 YI . SE , �u <br /> l <br /> Docusign Envelope ID:0E4C1828-AFOE-4EFC-BEDA 4 17CD95C t ` <br /> ::St:C7104.7 `•::'.:.:�:::;:;..::::�<�=�::::'::.:; �.:;::::;•��NA'i'lfREOF:•E1G11VG•(check•ailthat:apply)....::.:..;:.::::;..... ...... : . .•:•... :..-.• -•-- <br /> lJ New home to MHODS ❑ Adding or removing a co-owner ❑ Demolition(Date: ) <br /> • <br /> ❑ Used home sale ❑ Recording as real property ❑ Converted to storage <br /> ❑ Security interest change ❑ Removing from real property'status © Trip Permit • <br /> ❑ Transfer by inheritance ❑ Other(please note): <br /> >•SEGT[ON;2.:i.> :^::.:; :> '.:: AP,..PI:IGANT?1NF.ORMATION'{pieaseprint). .:::::.:........ <br /> ❑Dealer/Seller ❑Lender ❑Escrow/Title Agent ®Owner/Buyer ❑Legal Representative - <br /> Name. <br /> Urst,middle,last.)Ashley sshle Kallhoff Phone:503-580-4426 <br /> Address:5183 Center Street NE <br /> city:Salem State:OR ZIP:97317 <br /> Email:ashleykalihoff@gmail,com <br /> ::SECTION 3':':.;;::;. ?.;'; :' 'HOME:INFORMATION`{information•in bold is requir�ti) ::; ::::: .: ..:.:: ..... .. <br /> Home ID#:TBD OR No Home ID: ©New Home ❑Out of state home❑Leaving County Deed Records <br /> Manufacturer: Skyline IN 11/.3; <br /> Model:4402-6 Year:2025 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> 245-000-H-A102022A ORE 561577 <br /> 245-000-H Al02022B ORE 561578 <br /> #of Sections: 2 ••• Sq.footage: 1813 Bedrooms: 4 Bathrooms: 2 <br /> Roofing type: ACCH Comp Siding type: ACCH cement Heating type: Electric Cooling type: none <br /> Date ofsale: 5/14/2024 <br /> (lfupplic�ble) Sale price: 155641.00 Includes land: ElYes ID No <br /> IONi4=':•';::.;':.:';`;::: .;:. :::;; '�EAIsEf ':INFORMRTION:{leave'blankifno'dealer)'::::::.:::.: ::..: ;-:..,-. <br /> ndddleName:,laslj <br /> Champion Retail Housing Inc. License#:MSD1096 OJust, <br /> - Address:550 SW Booth Bend Road • <br /> city:McMinnville state:OR ziP:97128 <br /> -Email:crnulligan@championhomescenter.com • Phone:971-267-5024 • <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 unders at , g wed as evidence in court and is subject to a penalty of perjury, <br /> • • Signature: l,Gln.Jn.it, ('Afatn, iJ10/LUGS <br /> Date: <br /> SECT1ONi,.:. .zet�rib EAax4Ge:< HOME'LOCATION:°;:- <br /> • <br /> CurrentAddress:550 SW Booth Bend Road <br /> city:McMinnville county:Yamhill State:OR zip:97128 <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:17944 Elk Place <br /> City:Sublimity County:Marion State:OR zip:97385 <br /> Park Name:(IIf applicable) ❑This is adealer lot or storage facility <br /> Transporter Name:Blue Haul Phone:818-434-5501 <br /> Address:38681 Garden Drive City: Seio State:OR <br /> Email:blue.haui@yahoo.com <br /> Page 2 <br />