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Sunn j 6 olc. RASE -3 3 <br /> SECTION 1 NATURE OF FILING(check all that apply) <br /> EVi‘lahliniekti(1,65er a o er eiii lifter te: <br /> 2114 114 c rat r P rty M ge <br /> liestiiiar,eagane tfispettatus 0 Trip Permit <br /> er ce rWeitl'hef e): <br /> SECTION 2 APPLICANT INFORMATION (please print) <br /> Dealer/Seller ❑Lender ❑Escrow/Title Agent 0 Owner/Buyer ❑Legal Representative <br /> Name:Brian L. Fitterer Phone 503 364-4538 <br /> (first,middle,last) <br /> Address:4940 Sunnyside RD SE <br /> city:Salem state:Oregon ZIP:97302 <br /> Emailaunnyside@ipgliving.com <br /> SECTION 3 HOME INFORMATION (information in bold is required) . <br /> Home ID#: OR No Home ID: ❑New Home ❑Out of state home 0 Leaving County Deed Records <br /> Manufacturer:Fleetwood (4) 1' I a ci (a <br /> Model:Evergreen Year: <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> FLE2100 R24-24355A O RE565546 <br /> FLE21 R24-24355B ORE565547 <br /> #of Sections:` 2' Sq.footage: 1073 Bedrooms: 2 Bathrooms: 2 <br /> Roofing type: Comp Siding type: LP Smart Side Heating type: Heat Pump Cooling type Heat fump <br /> Date of sale: 12/1.0/24 Sale price: Includes land:- ❑Yes ❑No. <br /> afapplicable) <br /> SECTION 4 DEALER INFORMATION (leave blank if no dealer) <br /> Name Brian L. Fitterer I <br /> (first,middle, last) License#:IViSD410 <br /> Address:18006 Sky Park Cr Ste 200 <br /> City:Irvine State:CA ZIP:92614 <br /> Emaii:sunnyside@ipgliving.com Phone:503-364-4538 <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't 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:2655 Progress Way <br /> city:Woodburn county:Marion State:OR Zip:97071 <br /> Park Name: (if applicable) ❑® 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:4995 Sunnyside RD SE Lot W33 <br /> city:Salem County:Marion State:OR Zip:97302 <br /> Park Name: (if applicable) Sunnyside MHP ❑This is a dealer lot or storage facility <br /> Transporter Name:Dougs Mobile Home Service, Inc Phone:503-799-0539 <br /> Address:112692 Fry Rd NE City: Aurora State: Oregon <br /> Email:dugwalton@aol.com <br /> Page 2 <br />