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Authentisi§n ID.54BC24DA-EA52-F011-8F7C-000D3A8A9962 b8a Ln ncasE t ' c rn .9 73 1.�.� �R. �L� I�� � 1 <br /> SECTION 1 NATURE OF FILING(check all that apply) <br /> I New home to MHODS i o ' r 1/4.419ll vut(aatt: ) <br /> A rettAigNAAAIS N/kInglodkek,eksylVogipcy IELARkiflu inrike <br /> r us ❑ Trip Permit <br /> ViaNg0Colorigitr!ble 202)1 " <br /> SECTION 2 ~a; , APPLICANT INFORMATION (please print) ° <br /> ❑� Dealer/Seller ❑Lender ❑ Escrow/Title Agent ❑Owner/Buyer ❑Legal Representative <br /> Name. <br /> COMMONWEALTH HOMEOWNER SERVICES, INC. Phone:503-244-2300 <br /> first,middle, last) <br /> Address:18150 SW BOONES FERRY RD <br /> City:PORTLAND State:OR ZIP:97224 <br /> Email:MELISACOOK@CWRES.COM <br /> SECTION"3 HOME INFORMATION (information in bold is required), <br /> Home ID#: R1 eV1/4.1 OR No Home ID: New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:CAVCO MANUFACTURING,LLC:CAVCO MILLERSBURG (, 11138 <br /> Mode1:310PL15401A Year:2025 <br /> Serial Number(s) HUD Label Number(s) *Required if new home <br /> PHH3100R25-16389A ORE 567251 <br /> #of Sections: 1 - Sq.footage: 753 Bedrooms: 1 Bathrooms: 1 <br /> Roofing type:. SHINGLED Siding type: CEDAR Heating type: ELECTRIC Cooling type: NONE <br /> Date of sale: 4-25-25 ' Sale price: $80,290.60 Includes land: ❑Yes ❑Y No <br /> (if applicable) <br /> .``SECTION 4- :. �DEALER,INFORMATION (leave blank`if,no dealer) <br /> Name: - <br /> Urst,middle, last) License#: <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 LOCATION <br /> Current Address:3737 PALM HARBOR DR <br /> City:MILLERSBURG County:LINN State:OR Zip:97321 <br /> Park Name: (if applicable) CAVCO MANUFACTURING. LLC:CAVCO MILLERSBURG ❑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:4882 LANCASTER DR NE,SP.#142 <br /> City:SALEM Count :MARION State:OR Zip:97305 <br /> Y Y p <br /> Park Name: (if applicable) STARLITE MHP D 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 />