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Authentisign ID:54BC24DA-EA52-F011-8F7C-000D3A8A9962 0AI b Lan I/ I - . <br /> c�.<5 � U� �� I 3: ���,1ern etr7 3 i <br /> SECTION 1 NATURE OF FILING (check all that apply) , <br /> ❑� New home to MHODS di or er et i ' n te: ) <br /> ,I dy n a n ty 61 rt imstarage <br /> gr\SelatriPflsatorests,,Irange r p e atus I Trip Permit <br /> xalipByyince `\QkEkielvagesvote): <br /> SECTION 2 APPLICANT INFORMATION (pleaseprint) <br /> g Dealer/Seller E Lender ❑Escrow/Title Agent ❑OwnerBuyer ❑Legal Representative <br /> Name. <br /> 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:M ELISA COOK@CW RES.COM <br /> SECTION 3 HOME INFORMATION (information in bold is required) 7n <br /> Home ID#: NEW OR No Home ID: e❑New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:FLEEWOOD 6 3 ( ,7 <br /> Model 210EG28523P Year:2025 <br /> Serial Number(s) HUD Label Number(s) *Required if new home <br /> FLE2100R25-24611A ORE 566897 <br /> FLE2100R25-24611B ORE 566898 <br /> #of Sections: 2 Sq.footage: 1333 Bedrooms: 2 Bathrooms: 2 <br /> Roofing type: COMP .% _ Siding type: LAP CEMENT Heating type: ELECTRIC .Cooling type: NONE' <br /> Date of sale: 3-26-25 Sale price:$93,144 Includes land: E Yes ❑■ No <br /> (If applicable) <br /> SECTION 4 :' ;'= . DEALER INFORMATION (leave blank ifnodealer) ' <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:2655 PROGRESS WAY <br /> City:WOODBURN County:MARION State:OR Zip:97071 <br /> Park Name: (if applicable) E 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.#1013 <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 />