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Lebnco_61-er R SE 35' SaLL ot <br /> SECTION 1 :` :� =�` � �� .NATURE OF FILING(check all that apply)` , �� _ • <br /> 1 New home to MHODS r v' oer ei itio its? _ <br /> e m ecor ' g s r per y� nve o stora <br /> c ' mt st c e emo ' of ahpt er is 0 Trip Permit <br /> sf e ' re [li...P er(tnote): <br /> SECTION 2 .. `APPLICANT INFORMATION(please print) <br /> ❑■ Dealer/Seller ❑Lender ❑Escrow/Title Agent ❑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:97227 <br /> Email:MELISA.000K@CWRES.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:CLAYTON (z) OlL q J W <br /> Model:72DRM28523AH23 Year:2023 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> ALB0426900RA NTA 2182384 <br /> ALB0426900RA NTA 2182385 <br /> #of Sections: 2 Sq.footage: 1296 Bedrooms: 3 Bathrooms: 2 <br /> Roofing type: COMP Siding type: Cement Panel Heating type: ELECTRIC Cooling type: NONE <br /> Date of sale: 7-28-23 Sale price: $122,395 Includes land: ❑Yes 0 No <br /> afapplicable) <br /> 'SECTION 4°.``r"'°; DEALER INFORMATION(leave blank if 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: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: `._A..5.. C Date: ` /;fi/a3 <br /> SECTIONS +TOME LOCATION <br /> Current Address:2445 PACIFIC BLVD SW <br /> City:ALBANY County:LINN State:OR Zip:97321 <br /> Park Name: (if applicable) 0 This is a dealer lot or storage facility <br /> gg This home is being moved to a new location Complete the section below <br /> New Address:2410 LANCASTER DRIVE SE, SP. #357 <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 />