Laserfiche WebLink
� C <br /> Authentisign ID:54BC24DA-EA52-F011-8F7C-000D3A8A9962 0 L.?<1 , i_an c q s LY U -S i{�1 1 • Jo le-`^^. q 1 <br /> SECTION 1 _ NATURE OF FILING (check all that apply) <br /> ❑■ New home to MHODS [�Aykn i dpsinei- [h]L.15 + 151aCe: " ) <br /> IONA I}ao117p-sIte co i a N ve dlTN:.1 orage <br /> e e e n m pi tus ❑ Trip Permit <br /> IC/Pfall~bsthratice ei'(plea7t-note): <br /> • SECTION 2 APPLICANT INF,ORMATION'(please;print) <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#: Ij ay..) OR No Home ID: •New Home ❑Out of state home E Leaving County Deed Records <br /> Manufacturer:PALM HARBOR HOMES 73 65 <br /> Model:3104G28523A Year:2025 <br /> Serial Number(s) HUD Label Number(s) *Required if new home <br /> PHH3100R25-16294A ORE 566291 <br /> PHH3100R25-16294B ORE 566292 <br /> #of Sections: 2 Sq.footage: 1350 Bedrooms: 3 Bathrooms: 2 <br /> Roofing type: COMP Siding type: LAP CEMENT Heating type: ELECTRIC Cooling type: NONE <br /> Date of sale: 2-17-25 Sale price:$103,825.40 Includes land: ❑Yes ❑� No <br /> of applicable) <br /> Aa <br /> SECTION 4 -. • DEALER INFORMATION (leave blank it no dealer) ; <br /> Name: • <br /> 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:UNN State:OR Zip:97321 <br /> Park Name: (if applicable) ❑This is a dealer lot or storage facility <br /> 0 This home is being moved to a new location Complete the section below <br /> New Address:2410 Lancaster Dr SE SP.#1011 <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 />