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qq5 Sur) RoSL- L3 <br /> SECTION1 NATURE OF FILING(cheek all that apply) <br /> IgANOMOrrarICITiODS .. er <br /> Eritifailiane's-gyDI.RetiNia l rty -e Ithe storage'•. <br /> CS—Ere'ari4t3iNestchenge e • o TO atus 0 Trip Permit <br /> EkTrafi'f irltherhance 0--e er s ote): <br /> SECTION 2 APPLICANT INFORMATION(please print) <br /> - _- Dealer/Seller ❑Lender ❑Escrow/Title Agent 0 Owner/Buyer ❑Legal Representative - <br /> :.; <br /> _ (first,middle, last) <br /> Brian- Fitterer Phone 503 364 453$ <br /> Address:4940 Sunnyside RD SE <br /> City:Salem. state:Oregon ZIP:97302,.. <br /> Email:sunnyside@ipgliving.com <br /> SECTION,3 7 . HOME INFORMATION (information in bold is required) <br /> ;Home 1D#: NEV._ - OR No Home ID: ❑New Home- Out ofstate home D Leaving•County Deed-Records <br /> Manufacturer:Fleetwood . <br /> : Model:Sarfdpointe Year:2024 <br /> Serial Number(s) HUD Label Number(s)*Required if new home ' <br /> FLE2100R24-24345A ORE565530 <br /> ..1#,of Sections: 1 Sq.footage: 792 Bedrooms: 2 Bathrooms: 1 <br /> Roofing type. Comp Siding type: LP Smart Side Heating type: Heat Pump, Cooling type ;Heat Pump <br /> ;Date of sale:, 12/10/2.024 Sale nce: Includes land: ❑Yes <br /> ajappl:cable). l? ❑NO <br /> SECTION-4:-.. DEALER INFORMATION (leave blank k'f no dealer) <br /> Names <br /> (first,middle,last).BClan,L: Fitterer License#:MSD4I 0 <br /> Address:18005 Sky Park Cr Ste 200 <br /> City:Irvine State:CA ZIP:92614; <br /> Email:sunnyside@ipgliving.com Phone:503.-364-4538 <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 /> - legaI 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:2655 Progress Way <br /> City:Woodburn County:Marion State:Oregon Zip:97071 <br /> Park Name: of applicable) ❑® This is a dealer lot or storage facility <br /> d This home is being moved to a new location Complete the section below <br /> New Address:4995 Sunnyside RD SE 52p.W15 <br /> City:Salem County:Marion State:Oregon Zip:97302 <br /> Park Name:(if applicable) Sunnyside MHP ❑This is a dealer lot or storage facility <br /> Transporter Name:Dougs Mobile Home Service, Inc Phone: 503-799-0539 <br /> Address: 112692 Fry Rd NE City: Aurora State: Oregon <br /> Email:dugwalton@aol.com <br /> Page 2 <br />