Laserfiche WebLink
Authentisign ID:54BC24DA-EA52-F011-8F7C-000D3A8A9962 a A I D L anc a I�if O I1 oo� S��1�. 3 <br /> c5�' S 11 1111 vi 6 II <br /> SECTION 1 NATURE OF FILING (check all that apply) <br /> 0 New home to MHODS o • g er [ D rt r ate: <br /> DVASKU1 A...ale co d• arty No eer ge <br /> Kfr\SeXipitNjAtersostNelatige [VRe vit of ea op s tus [ .Trip Permit <br /> �eiulieFh�nce ote): <br /> SECTION 2 , : APPLICANT INFORMATION (please rint) <br /> ❑� Dealer/Seller ❑Lender ❑Escrow/Title Agent ❑Owner/Buyer ❑Legal Representative <br /> Name:COMMONWEALTH HOMEOWNER SERVICES, INC. Phone: <br /> (first,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#:. Nevi OR No Home ID: ❑� New Home E Out of state home ❑Leaving County Deed Records <br /> Manufacturer:PALM HARBOR HOMES bi 3(0 I <br /> Mode1:3104G28441A Year:2025 <br /> Serial Number(s) HUD Label Number(s) *Required if new home <br /> PHH3100R25-16316A ORE 566327 <br /> PHH3100R25-16316E ORE 566328 <br /> #of Sections: 2 Sq.footage: 1220 Bedrooms: 2 Bathrooms: 2 <br /> Roofing type: COMP . Siding type: FIBERCEMENT . Heating type: ELECTRIC Cooling type: NONE <br /> Date of sale: 2-28-25 Sale price:$101,665 Includes land: ❑Yes ■❑No <br /> (If applicable) <br /> SECTION_4 DEALER INFORMATION (leave blank ifno dealer) , <br /> Name: License#: . <br /> (first, middle,last) <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 /> ❑� This home is being moved to a new location Complete the section below <br /> New Address:2410 Lancaster Dr SE SP.#1007 <br /> City:SALEM County:MARION State:OR Zip:97317 <br /> Park Name: (if applicable) SUNDIAL MHP E 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 />