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. 4ff 15 3ü )e :NG <br /> . 34,)ekyl <br /> �ECTtC3N�i r,k�K �'��; Y� .m NA`CURE QF FILING;(check`aII that apPIY3. :3 Y `� �` �_ <br /> 4r, i" C k 1T k �"i S y� } <br /> 0 New home to MHODS acotigtaher � <br /> Vi\ld echo s c t` P P., ee . . et ge <br /> D Security interest change [-}..IZ t t eNt us s❑ Trip Permit <br /> �il het/taace L�Ott' ' <br /> SECTION42 ,,s r. ,`$ *: APPLICANT INFORMATION(please print) .:: r : <br /> ❑Dealer/Seller ❑Lender ❑Escrow/Title Agent E Owner/Buyer" El Legal Representative <br /> Name:Patricia Gray <br /> (frst,'middle,"last) Phone:503-932-9136 <br /> Address;•4915 Swegle Road NE#17 <br /> City:Salem State:OR ZIP:97301 <br /> Email:patti.grayl 8@yahoo_com <br /> y SECTI0Ns3 fry_}�. : 7>` HOMEIIF$ORMATIO `(info n bold is required) x L <br /> Home ID#: OR No Home ID: ❑New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:Champion Home Builder Ca l t + 5 1 <br /> Model:Champion Winchester Year:2024 ` <br /> _Serial Number(s) HUD Label Number(s)*Required if new home <br /> 017-00P-H-A004351A I DA257352 <br /> • <br /> #of Sections: 1 Sq.footage:. 1024 Bedrooms: 2 Bathrooms: <br /> 2 - : <br /> Roofing type: -ram'.=rpo Siding type: Vinyl Heating type: electric- Cooling type: <br /> :P'umP • <br /> Date pf sale: <br /> (/japplkablel, 11/25/25 Sale price: 113,000 Includes land:- ❑Yes 0 No - - <br /> SECTION°4a ' , r; x„S„ «".,x , ,DEALER INFORMATION(leave'.blank(if no dealer) ;3 " a <br /> -Name _ <br /> �ti �:.< . I.:a <br /> (Test;middle;last)Amber Homes, LLC License#:MSD820 - " <br /> Address:330 Rayford Rd.#312 <br /> City:Spring State:TX ZIP:77386 <br /> Email:finance@amberhomes.us Phone:650-946-2916 <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: <br /> C Date: 121 p 2)2� <br /> � �� HOME LOCATION ` � f <br /> Current Address:4915 Swegle Road NE#17 <br /> City:Salem County:Marion State:OR Zip:97301 <br /> Park Name:(if applicable) Sunset Village MHC ❑This is a dealer lot or storage facility <br /> ❑This home is being moved to a new location Complete the section below <br /> t"")c Address: <br /> 1425 R SUnntsid�, d. <br /> City: Weiser County:WtSki n n State:. I Zip: 3 67 2 <br /> Park Name:(if applicable) ❑This is a dealer lot or storage facility <br /> li Transporter Name: Phone: <br /> Address: City: State: <br /> Email: <br /> Page 2 <br />