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D-D-3 -ID - Ave_ sE 118 S <br /> , cuk-irn 61.1 31 <br /> Authentisign ID:99608967-2D90-EF11.8473.002248299057 <br /> SECTION 1 NATURE OF FILING(check all that apply) <br /> E] New home to MHODS c rla'iaeaGattb'u er 10\4racei.e tc� <br /> t d'hbt rtaie 10442614 dhillartlixqtY IKI' ve efl t6lstorage <br /> 'clA,b'aft3iif5 St c/fikf nge t g l,r4ipVI talus El Trip Permit <br /> \TragratlSj.ittlialitilUee taAttiar. 61etiM tom: • <br /> SECTION 2 APPLICANT INFORMATION(please print) <br /> Dealer/Seller ❑Lender ❑Escrow/Title Agent ❑Owner/Buyer ❑Legal Representative <br /> Name. <br /> 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 bold is required) <br /> Home ID#:Nje W OR No Home ID: Q New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:CLAYTON • l0 06 cf cp"1 <br /> Mode1:72IKC28563RH24 Year:2024 I <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> ALB0436340RA ORE 564961 <br /> ALB043634ORB ORE 564962 <br /> • <br /> #of Sections: 2 Sq.footage: 1512 Bedrooms: 3 Bathrooms: 2 <br /> Roofing type: COMP Siding type: Vertical Smart Panel Heating type: ELECTRIC Cooling type: NONE <br /> Date of sale: <br /> (If applicable) Ck—a- `1 Sale price: IA 1a Includes land: ❑Yes ❑No <br /> SECTION 4 DEALER:INFORMATION(leave blank if no dealer) <br /> Name: <br /> (first,middle,last) License#: <br /> Address: <br /> City: _ State: ZIP: <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 /> CityALBANY County:LINN State:OR Zip:97321 <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:2232 42ND AVENUE SE,SP.#118 <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 /> • <br /> Page 2 <br /> 1 <br />