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Docusign Envelope ID:04463696-0A5D-4313-8FED-8C042BCEA5EC ce, (8 r i ,,f-u3O0 c (� <br /> SECTION 1 NATURE'OF FILING (check all that apply) <br /> ❑� New home to MHODS er m 'to ) <br /> UkAZ5 b ° adektedk'dst ge <br /> P i i eYolleiage c tus El Trip Permit <br /> SECTION 2' ' APPLICANT INFORMATION (please print) <br /> ❑e Dealer/Seller ❑Lender ❑Escrow/Title Agent ❑Owner/Buyer ❑Legal Representative <br /> Name:Brian L. Fitterer Phone: <br /> (first,middle,last) <br /> Address:18006 Sky Park Circke#200 <br /> City:Irvine State:CA ZIP:92614 <br /> Email: <br /> SECTION 3 ° . KHOME`INFORMATION'(information in bold is required), ;';� �.t�� � � <br /> Home ID#: E W OR No Home TD: 0 New Home El Out of state home ❑Leaving County Deed Records <br /> Manufacturer: Fleetwood Cf2 114'9 <br /> Model:Evergreen Year:2025 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> FLE2100R24-24463 NB 566214 <br /> 566215 <br /> #of Sections: 2 Sq.footage: 1333 Bedrooms: 2 Bathrooms: 2 <br /> Roofing type: COMP • Siding type: Vinyl Heating type: HP Cooling type: HP <br /> Date of sale: 01/2025 Sale <br /> afapplicable) price: <br /> 93,$$7.00 Includes land: ['YesNo <br /> SECTION 4 ,` 'DEALER.INFORMATION (leave blank if no dealer) -. <br /> Name:Brian L. Fitterer Inc License#:MSD410 <br /> (first,middle,last) <br /> Address:18006 Sky Park Circle Suite 200 <br /> City:Irvine State:CA ZIP:92614 <br /> Email:briarwood@ipgliving.com Phone:503.581.7820 <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 understahTiP8aVVe used as evidence� in court and is subject to a penalty of perjury. <br /> Signature: zt. livu i'tbS Date: 3/28/2025 <br /> 37306341AD881rD, <br /> SECTIONS • . HOME LOCATION <br /> Current Address:2655 Progress Way <br /> City:Woodburn County:Marion State:OR Zip:97071 <br /> Park Name: (if applicable) 0 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:5056 Briarwood Circle N 4 D., <br /> City:Keizer County:Marion State: OR Zip:97303 <br /> Park Name: (if applicable) Briarwood Estates ❑This is a dealer lot or storage facility <br /> Transporter Name: Doug Walton Phone: 503-799-0539 <br /> Address: City: Aurora State: OR <br /> Email: <br /> Page 2 <br />