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AL <br /> D Lax\ca.5-eY ° R cb <br /> 'SECTION 1 : ° - - NATURE OF.FILING(check all that'apply) ` <br /> 0 New home to MHODS ID.AddlogbrirdiuSkivner 411it1itn f e: ) <br />' glt,0,46Stfidistile 84.0(iirle r'eariattpkrty [ i i A h rage <br /> 0 Security interest change t,/Wfgekageftita1'vrtVeakat4us [ / r1}rPlerrth t <br /> Asab'y4nfetrtGe EVIlhereteeke,Rork <br /> SECTION-2 APkICANT INFORMATION (please print) <br /> E❑Dealer/Seller ❑Lender ❑Escrow/Title Agent 0 Owner/Buyer ❑Legal Representative <br /> Name:COMMONWEALTH HOMEOWNER SERVICES Phone:503-244-2300 <br /> (first,middle, last) <br /> Address:18150 SW BOONES FERRY ROAD <br /> City:PORTLAND State:OR ZIP:97224 <br /> Email:MELISA.COOK@CWRES.COM <br /> SECTION'3." ' HOME INFORMATION(information'in`b o °did is required) ,. <br /> 1 Home ID#:TBD OR No Home ID: 0 New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:CLAYTON CO 0 73 5 5 <br /> i. <br /> Model:72DRM28523AH25 Year:2025 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> ALB044643ORAB ORE 569134 <br /> ALB044643ORAC ORE 569135 <br /> #of Sections: 2 Sq.footage: 1404 Bedrooms: 3 Bathrooms: 2 <br /> Roofing type: CO MOP Siding type: Lap Cement Heating type: ELECTRIC Cooling type: HEAT PUMP <br /> Dateofsale: 4-17-26 Sale price: $189,900 Includes land: ❑Yes ❑� No <br /> Qfapplicable) <br /> 'SECTION 4, DEALER INFORMATION(leave blankif no dealer) . <br /> Name:COMMONWEALTH HOMEOWNER SERVICES, INC. License#:MSD508 <br /> (first,middle,last) <br /> Address:18150 SW BOONES FERRY ROAD . <br /> City:PORTLAND State:OR ' ZIP:97224 <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:2445 PACIFIC BLVD SW <br /> City:ALBANY County:LINN State:OR Zip:97321 <br /> Park Name:(if applicable) ❑This is a dealer lot or storage facility <br /> ❑I This home is being moved to a new location Complete the section below <br /> New Address:2410 LANCASTER DRIVE SE, SP. #1001 • <br /> City:SALEM County:MARION State:OR Zip:97317 <br /> ` Park Name:(tf applicable) SUNDIAL MHC • ❑This is a dealer lot or storage facility <br /> Transporter Name:NEWMANS MOBILE HOME TRANSPORT Phone: 503-932-5142 <br /> Address:PO BOX 236 City: SILVERTON State: OR <br /> Email: , <br /> Page 2 <br /> si <br />