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9'8 4 Go I -C Cl L,b Rd, 44 , S-4. 1'0v\ <br /> Authentisign ID:5732DAA2 502C F011-8B3D-00224822F75A <br /> SECTION 1 NATURE.OF FILING (check all that apply) <br /> O New home to MHODS ❑ Adding or removing a co-owner ❑ Demolition(Date: ) <br /> ❑ Used home sale ❑ Recording as real property _ ❑ Converted to storage <br /> ❑ Security interest change ❑ Removing from real property status 0 Trip Permit <br /> ❑ Transfer by inheritance ❑ Other(please note): <br /> SECTION 2 APPLICANT INFORMATION (please print) <br /> 0 Dealer/Seller ❑Lender ❑Escrow/Title Agent ❑Owner/Buyer ❑ Legal Representative <br /> Name:COMMONWEALTH HOMEOWNER SERVICES Phone:503-244-2300 ' <br /> Urst,middle;last) <br /> Address:18150 SW BOONES FERRY ROAD <br /> City:PORTLAND State:OR ZIP:97224 <br /> Ema il:M ELISA.COOK@CW RES.COM <br /> SECTION 3 ` ' HOME INFORMATION (information in bold is required) <br /> Home ID#:LIE'^/ OR No Home ID: 0 New Home ❑Out of state home El Leaving County Deed Records <br /> Manufacturer:CHAMPION HOMES ] d (e 3•5 <br /> Model:RIDGEWOOD Year:2025 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> 245-000HA101984A ORE 564899 <br /> 245-000HA101984B ORE 564900 <br /> #of Sections: 2 - Sq.footage: 1380 Bedrooms: 4 Bathrooms: 2 <br /> Roofing type: COMP Siding type: LAP CEMENT PANEL Heating type: ELECTRIC Cooling type:. NONE <br /> Date of sale: 5-8-25 Sale price: $110,394 Includes land:_ ❑Yes 0 No <br /> (Ifapplicable) _ <br /> SECTION.4 DEALER INFORMATION (leave blank if no dealer) . <br /> Name'COMMONWEALTH HOMEOWNER SERVICES,INC. - License#:MSD508(first,middle,last) <br /> Address:18150 SW BOONES FERRY ROAD <br /> City:PORTLAND State:OR ZIP:97224 <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 undersAuthenh5itand it can be used as evidence in court and is subject to a penalty of perjury. <br /> Signature: Chris' 6uethS'eyl Date: 05/14/25 <br /> SECTION 5 HOME LOCATION <br /> Current Address:550 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:9874 GOLF CLUB ROAD,SP.#46 <br /> City:STAYTON County:MARION State:OR Zip:97383 <br /> Park Name: (if applicable) OAK ESTATES ❑This is a dealer lot or storage facility <br /> Transporter Name:. Phone: <br /> Address: City: State: <br /> Email: <br /> Page 2 <br />