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MANUFACTURER'S STATEMENT OR CERTIFICATE OF ORIGIN TO A MANUFACTURED HOME
<br /> FIRST ASSIGNMENT
<br /> MANUFACTURER:Fleetwood Homes For Value Received,the undersigned hereby transfers this Statement of Origin and the manufactured
<br /> home described therein to: C(>j„ SL,--.(C,:;tr.G C ,,ti a,— V t'.-%
<br /> ADDRESS: 2655 Progress Way,Woodbum,OR 97071 Address:.\:,V't S,.O .,,, G�:_,_ . t'A p --• --,. , ;vi.y-N c\
<br /> and certifies that the home is new and has not been registered'm this or any other state;he also warrants •
<br /> Street,City,State,and Zip the title of said home at time of delivery,subject to the liens and encumbrances,if any,as set out below
<br /> Amt.Of Lien Date To Whom Due Address
<br /> ---_ -�"
<br /> The undersigned MANUFACTURER hereby certifies that the new manufactured home described below; ' Dated , at f'�
<br /> y s
<br /> the property of said MANUFACTURER,has been transferred ' J'" /
<br /> t,,,,C4'st4'ti�1*.a r(l `x�.S)fix.,,\fl r^-s..'4�"..�Y� ,f �.. ,J-�.----- '2r�-"
<br />. this 26th dayof March , 2025 on Invoice No 202592715700 Transferor(Firm Name) f/ S' u Here Position 1
<br /> Dealer License(Permit)No. ,'.."..Sr s e-,r >
<br /> Before me personally appeared (:,N C (*Cr ati-..:.8:}..+., - who by me being
<br /> To: COMMONWEALTH HOMEOWNER SERVICES,INC. uuty� ,I ii q says that tie statements set forth above are true and correct.
<br /> l.. 140 Sub ; q.s gi to before ne this 1 day of t`n..n t , c',-�i
<br /> Distributor,Dealer,Etc. t. �•` '
<br /> „- ' N i tar}Public for a T� nc '.k•-••<,-. 76"ounty,State of _/1 r,,ti . ,-.....
<br /> Whose Address is: 18150 SW BOONES FERRY ROAD COMMISSIOPSNO.1014450
<br /> Street MY COMM1SSSION EXPIRES JULY 08,2025 SECOND ASSIGNMENT
<br /> For Value Received,the undersigned hereby transfers this Statement of Origin and the manufactured
<br /> PORTLAND,OR 97224 home described therein to:
<br /> -City,State,and Zip Address:
<br /> and certifies that the home is new and has not been registered in this or any other state;he also warrants
<br /> Trade Name: 210EG-Eaqle-28523P Model Year: 2025 the title of said home at time of delivery,subject to the liens and encumbrances,if any,as set out below
<br /> Amt.Of Lien Date - To Whom Due Address
<br /> Model No: 210EG28523P Body Width Ft: 26'8"
<br /> Body Length Ft: 56'0" /Ft: 52'0" Dated , at
<br /> Including Hitch • Excluding Hitch .By:
<br /> Transferor(Firm Name) Sign Here Position
<br /> Square Feet: 1333 Date of Manufacture: 03/25/2025 Dealer License(Permit)No.
<br /> Before me personally appeared who by me being
<br /> Manufacturer's ID No: FLE2100R25.24611 A Weight: 20,480 duly sworn upon oath says that the statements set forth above are true and correct.
<br /> Subscribed and sworn to before me this day of ,
<br /> Manufacturer's ID No: FLE210OR25-24611 B Weight: 18,870 Notary Public for _County,State of
<br /> Manufacturer's ID No: Weight: Notary Seal
<br /> THIRD ASSIGNMENT
<br /> Manufacturer's ID No: Weight: For Value Received,the undersigned hereby transfers this Statement of Origin and the manufactured
<br /> Manufacturer's ID No: Weight: home described therein to:
<br /> Manufacturer's ID No: Weight: Address:
<br /> and certifies that the home is new and has not been registered in this or any other state;he also warrants
<br /> the title of said home at time of delivery,subject to the liens and encumbrances,if any,as set out below
<br /> The CORPORATION further Certifies that this was the first transfer of such new manufactured home in • Amt.Of Lien Date To Whom Due' Address
<br /> ordinary trade and commerce.
<br /> Fleetwood Homes Dated , at
<br /> - • By:
<br /> ti Corporation Transferor(Firm Name) Sign Here Position
<br /> 4 R7- Dealer License(Permit)No. •
<br /> By: C.-7'2"R c"' C c.,„pi •" , _v. • Before me personally appeared who by me being
<br /> Sign Name Titi ror Position duly sworn upon oath says that the statements set forth above are true and correct.,
<br /> 2655 Progress Way,Woodbum,OR 97071 . . Subscribed and sworn to before me this day of ,
<br /> • Notary Public for County,State of
<br /> Office Address of Signatory(City&State)
<br /> Notary Seal
<br />
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