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Docusign Envelope ID:AEBFBE87-4AB1-43CE-B839-AB60D9717C60 <br /> i vex 'Road kJ tea , )��;2E,1/ <br /> SECTION 1 NATURE OF 1 G(check;all that applyT <br /> IN New home to MHODS ' A i b o �i'oaingaco-owner ate: <br /> 1[2Vcrs rl emeje eco b asgaipcIperty o o storage <br /> 1✓S�e tereetlhange o p status ® Trip Permit <br /> ra iaiiatanee 17N-9tlicer ktgrnoteji <br /> SECTION 2' • APPLICANT_1NFOl2MATION(please prirft)_ ' <br /> EJ Dealer/Seller ❑Lender ❑Escrow/Title Agent IN Owner/Buyer El Legal Representative <br /> Name: Phone: <br /> (first,middle,last) Brian L Fitterer, Inc rsn31 3na-nnn3 <br /> Address: 18006 Sky Park Circle Suite 200 <br /> City: Irvine State:CA ZIP:92614 <br /> Email:mcnary@ipgliving.com <br /> SECTION 3 HOME II FORMI�TIOIV(ln ar aat an ity bald:is rec{ttrtre <br /> • <br /> Home iD#: vs OR No Home ID: ®New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer: Fleetwood Evergreen (I i `Uo 5 <br /> Model: 210EV24403E Year:2025 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> FLE 2100R24-24425A ORE 566164 • <br /> FLE2100R24-24425B ORE 566165 <br /> • <br /> #of Sections: 2 Sq.footage: 933 Bedrooms: 3 Bathrooms:' 2 <br /> Roofingtype: Arch. Shingle Sidingtype: ardie panel_ Heating type: Forced Cooling type: <br /> Date of sale: Sale <br /> p , es <br /> (IfapPlicable) i�1/jaba� alerice: Includesland: ❑Yes ®No <br /> 5ECTION 4: .': .:DEALER INFOl MATION Oeauebfank rfi n_n dealer) <br /> Name: <br /> (first,middle,last) Brian L Fitterer, Inc License#:MSD410 <br /> Address: 18006 Sky Park Circle Suite 200 <br /> City:Irvine State:CA L1x:92614 <br /> Email:clairmontOipglivinq.com Phone: (503) 665-5421 <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 napuks.kgrad structure or my interest in it.The information listed is true to the best of my loiowledge and <br /> belief,and I understand rt cu.be used as Gvidgncei court and is subject to a penalty of perjury. <br /> A VL 2/3/2025 <br /> S'lgnature. Bate: <br /> -373D5344AD884FD... <br /> 5ECT1ON 5 .__ HOME LDC.ATIOTd <br /> Current Address:2655 Progress Way <br /> City:Woodburn " County:USA State:ORE 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:5355 River Rd N #72 <br /> City: Keizer County: USA State:QRE Zip:97303 <br /> Park Name:(if applicable)MCNary Oaks Mobile Village ❑This isa dealer lot or storage facility <br /> Transporter Name:Doug Walton • Phone:(503) 799-0539 <br /> Address:12692 Fry Rd. NE City:Aurora State:ORE <br /> Email: duwalton@aol.com <br /> Page 2 <br /> 1 <br />