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D D <br /> AulhentisignlU cgAI Lan <br /> .:548C24DA-EA52-F011-BF7C-OOOD3A8A9962 CQ� � S���oa� Jew) � <br /> r � � ��l V �r7 <br /> SECTION 1 NATURE OF FILING (check all that apply) <br /> ❑� New home to MHODS er tg/tD r llti6\.(4 ate: <br /> D Ii 164:44* e ► erh "AlAanztato,stoirEe <br /> VAtteNINIT/trgtVhsuige o e tus ❑� Trip Permit <br /> ^Tr er' ce <br /> SECTION 2 APPLICANT INFORMATION (please print) <br /> ❑Dealer/Seller ❑Lender ❑Escrow/Title Agent ❑ Owner/Buyer ❑ Legal Representative <br /> Name:COMMONWEALTH HOMEOWNER SERVICES,INC. Phone: <br /> Uirst,middle, last) <br /> Address:18150 SW BOONES FERRY RD <br /> City:PORTLAND State:OR ZIP:97224 <br /> Email:MELISA.COOK@CWRES.COM <br /> SECTION 3 .` HOME INFORMATION (information,in bold is required) <br /> Home ID#:v j'£ki OR No Home ID: Q New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:PALM HARBOR HOMES &b135 <br /> Model:3104G28441A Year:2025 <br /> Serial Number(s) HUD Label Number(s)*Required if new.home <br /> PHH3100R24-16284A ORE 566274 <br /> PHH3100R24-16284E ORE 566275 <br /> #.of Sections: 2 Sq.footage: 1188 Bedrooms: 2 Bathrooms: 2 <br /> Roofing type: COMP. Siding type: LAP CEMENT Heating type: ELECTRIC Cooling type: NONE <br /> Date of sale' 1-31-25 Sale price:$100,275.80 Includes land: ❑_Yes D No <br /> (I./'apptrcable). <br /> SECTION 4 DEALER INFORMATION (leave blank if no dealer) <br /> Name: <br /> (first,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) ❑This is a dealer lot or storage facility <br /> If This home is being moved to a new location Complete the section below <br /> New Address:2410 Lancaster Dr SE SP.#1003 <br /> City:SALEM County:MARION State:OR Zip:97317 <br /> Park Name: (if applicable) SUNDIAL MHP ❑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 />