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DDA (-)N Shq-cr el SE AU-P/15Q 111`e en 3 s <br /> SECTION 1 NATURE OF FILING (check all that apply) <br /> ❑� New home to.MHODS A d' g o• e ov' pr ler e o ' of Date ) <br /> e e IK/Rcs fddn a,Lp ot9erty ClAcanyeritte.s1A6Vorl.ge <br /> w' t st _ nge INO/Ren v' .cedU p��r tatus ] Trip Permit <br /> r isfe ' stance t • e ote : <br /> SECTION 2 APPLICANT INFORMATION (please print) <br /> ❑� Dealer/Seller ❑Lender ❑Escrow/Title Agent ❑ Owner/Buyer ❑Legal Representative <br /> Name:Tri City Mobile Estates LLC Phone:503-522=0856 <br /> (first,middle, last) <br /> Address:PO Box 10 <br /> City:Sandy State:OR ZIP:97055 <br /> Email:trimblerentals@gmail.com <br /> SECTION 3 HOME INFORMATION (information in bold is required) .. <br /> Home ID#: ! ) OR No Home ID: Q New Home .❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:Cavco 62 I '3 1'2) <br /> Model:210PU28483U Year:2025 <br /> Serial Number(s) HUD Label Number(s) *Required if new home <br /> CAV2100R25-25323A <br /> CAV2100R25-25323B <br /> #of Sections: 2 Sq.footage: 1,280 Bedrooms: 3 Bathrooms: 2 <br /> Roofing type: architectural composite Siding type: vertical cement Heating type: electric Cooling type: n/a <br /> Date of sale: ,. .• <br /> af applicable) <br /> 12/25/25 Sale price: $85,945 Includes land: ❑Yes El No <br /> SECTION 4 . DEALER INFORMATION (leave blank if no dealer) <br /> Name:Trl CityMobile Estates LLC •License#:MSD 1091 <br /> first, middle, last) <br /> Address:PO Box 10 <br /> City:Sandy State:OR ZIP:97055 <br /> Email:trimblerentals@gmail.com Phone:503-522-0856 <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:12/2/25 <br /> r <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) ❑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:10042 Shaff Road SE <br /> City:Aumsville County:Marion State: OR Zip:97325 <br /> Park Name: (if applicable) ❑This is a dealer lot or storage facility <br /> Transporter Name: Doug's Mobile Home Service Phone: 503-799-0539 <br /> Address: 12692 Fry Road NE City: Aurora State: OR <br /> Email:dugwalton@aol.com <br /> Page 2 <br />