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Authentisign ID:54BC24DA-EA52-F011-8F7C-000D3A8A9962 ' <br /> 3�lD �-czr)ca.61ev (-4. 1b10 , 8alevv‘ 973t <br /> 7 <br /> SECTION 1` NATURE OF FILING (check all that apply) <br /> ❑■ New home to MHODS n i er <br /> NO/1Lisleel l}6dtel4rke e • veA.AvtatAl-t nste.rage <br /> g e 1 r atus ❑� Trip Permit <br /> 9vistiSki.tmiCe ) <br /> SECTION 2 APPLICANT INFORMATION (please print) <br /> 0 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. " <br /> bold is required) '�.a°", 9 d.. . . . �. <br /> Home ID#: E W OR No Home ID: ❑New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:PALM HARBOR HOMES (,0-136 - <br /> Model:3104G28563B Year:2025 <br /> Serial Number(s) HUD Label Number(s) *Required if new home <br /> PHH3100R25-16302A ORE 566302 <br /> PHH3100R25-16302B ORE 566303 <br /> #of Sections: 2 Sq.footage: 1445 Bedrooms: 3 Bathrooms: 2 <br /> Roofing type: COMP. Siding type: FIBERCEMENT Heating type: ELECTRIC Cooling type: NONE. <br /> Date of sale: 2-21-25 Sale price:$123,450.50 Includes land: ❑Yes ■❑No <br /> afapplicable) <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 r 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.#1010 <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 />