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Docusign Envelope ID:C6EF05BE-$C36-4235-B140-260396E62C42 <br /> 4qb St,unn 5io). RJSE ' 2 <br /> , S . ) <br /> SECTION 1 NATURE OF FILING(check all that apply) <br /> i] New home_to MHODS er allitfi (7}Zate: ) <br /> er3v4spsljacisale `Q'\geror31u e p v ffdditD.storage <br /> iDnaeovityinttrz hange em 1 o r tus D.26 Pemut. <br /> alaatrkspe e ele): <br /> SECTION2 APPLICANT INFORMATION (please print) <br /> 0 Dealer/Seller ❑Lender 0 Escrow/fide Agent ❑Owner/Buyer ❑Legal Representative <br /> Name:Brian L. Fitterer, Inc <br /> (first,middle,last) Phone:503-364-4538 <br /> Address:4940-Sunnyside Rd SE <br /> City:Salem State:Oregon ZIP:97302 <br /> Email:sunnyside@ipgliving.com <br /> SECTION 3 HOME INFORMATION (information in bold•is required) <br /> Home ID#: Alij OR No Home ID: 0 New Home 0 Out of state home 0 Leaving County Deed Records <br /> Manufacturer:SkylinetO I t <br /> 3 <br /> Model:P1J704 <br /> Year:2025 <br /> Serial Number(s) HUD Label Number(s)*Required if home <br /> 245-000-H-A10241A O RE561599 <br /> 245-000-H-A10241 B ORE561600 <br /> #of Sections: 2 Sq.footage: 960 Bedrooms: 2 Bathrooms; 2. ; <br /> Roofing type: Comp - - Siding type: Fiber Cement Heating type: Heat Pump Cooling type:. HP"_ <br /> Dateof sale: I 18/2026 Sale price: 112000 Includes land:gjapplicable) ❑Yes No <br /> SECTION DEALER INFORMATION(leave blank if no dealer) <br /> Name:Brian L. Fitterer Inc <br /> (first,middle,Iasi) <br /> License#:MSD410 <br /> •Address:4940 Sunnyside RD SE <br /> City:Salem _ State:Oregon ZIP:97302 <br /> Email:.sunnyside@ipgliving.com Phone:5033644538 <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 rnvi,40,ired structure or my interest in it.The information listed is true to the best of my knowledge and <br /> belief,and I understa d 4,ean be used s evidence in court and is subject to a penalty of perjury. <br /> Signature: '4/ituitlitzt tt, --5 <br /> 373D5344AD884FD... Date: 1/22/2026 <br /> SECTION5 _ HOME LOCATION 1 <br /> Current Address:4940 Sunnyside RD SE K2 <br /> City:Salem County:Marion State:Oregon Zip:97302 <br /> Park Name:(if applicable) Sunnyside Mobile Home Park ❑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: <br /> City: County: State: Zip: <br /> Park Name:(if applicable) ❑This is a dealer Iot or storage facility <br /> Transporter Name: Phone: <br /> Address: City: State: <br /> Email: <br /> Page 2 <br />