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41- <br /> - 11- 19&000D E5 �OS ` Y a1 l /A �.e 3 E I I O ( . `'U. V� ' i' 3 V <br /> Authenlisign ID.F398E1AF-90C9 FO 8 tt" �� <br /> SECTION 1 ..NATURE OF FILING (check all that apply) <br /> ❑� New home to MHODS Cl/Skclekgear.enleyngoftc4144ner ®/D oyitiaaate: ) <br /> [Q' 6`keeku o L p y [ t•..ccrAgted‘t•cl.sterage . <br /> [ yi'itYdirrterzist-ckalige e tus El Trip Permit <br /> ❑kAti e�l1ut/Ace [ Ot}1 n e : <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:97224 <br /> Email:MELISA.COOK@CWRES.COM <br /> SECTION 3 HOME INFORMATION (information in bold is required): <br /> Home ID#: OR No Home ID: ®❑New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:CAVCO MILLERSBURG "— <br /> Mode1:3104G24402A Year:2026 <br /> Serial Number(s) HUD Label Number(s) *Required if new home <br /> CAV3100R25-16565A ORE 568426 <br /> CAV3100R25-16565B ORE 568427 <br /> #of Sections: 2 Sq.footage: 865 Bedrooms: 2 Bathrooms: 2 <br /> Roofing type: COMP • Siding type: FIBERCEMENT Heating type: ELECTRIC Cooling type: NONE. <br /> Date of sale: 11-10-25 Sale price: $96,425 Includes land: ❑Yes 0 No ' <br /> afapplicable) <br /> SECTION 4 DEALER INFORMATION (leave blank if no dealer) <br /> Name' <br /> 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 <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 /> �—Artharti.•r•+ <br /> Signature: C/irk' 6uei-h5'ey Date: 11/25/25 <br /> SECTION 5 HOME LOCATION <br /> Current Address:3737 PALM HARBOR DRIVE <br /> City:MILLERSBURG County:LINN State:OR Zip:97321 <br /> Park Name: (if applicable) E 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.#101 <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 />