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4 R L�.n►n , al? Po) 0 <br /> Docusign Envelope ID:A5A82864-DDFF-4F38-82F4-1 F6AC3958D71 'd <br /> SECTION 1 NATURE OF FILING (check all that apply) <br /> mArky11a14 oriS Sa\Add ng,o(remQvjng a.�o owner ❑ ip6iiti u( te:. ) <br /> [ 'Fide} o ' g •e 9e e2ty N-Oer Q.tatc orage <br /> e u 'tom re t'ishaatge ovi re r rt status ■❑ Trip Permit <br /> [Sr-Van e n e ance 4 pareez©t <br /> SECTION 2 APPLICANT INFORMATION (please print) <br /> ❑■ Dealer/Seller ❑Lender ❑Escrow/Title Agent ❑ Owner/Buyer ❑Legal Representative <br /> Name:Brian L. Fitterer, Inc Phone:5033644538 <br /> (first, middle, last) <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#: g OR No Home ID: . ❑New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:Champion (� 11,3 , 9 <br /> Model:P1 J704 Year:2025 <br /> Serial Number(s) HUD Label Number(s) *Required if new home <br /> 245-000-H-A102016A ORE561567 <br /> 245-000-H-A102016B ORE561568 <br /> #of Sections: 2 Sq.footage: 960 Bedrooms: 2 Bathrooms: 2 <br /> Roofing type: Camp Siding type: Hardi Heating type: Heat Pump Cooling type: Heat Pump <br /> Date of sale: /30/2026 3 Sale price: 115000 Includes land: ❑Yes No <br /> (If applicable) <br /> SECTION 4 DEALER INFORMATION (leave blank if no dealer) <br /> Name:Brian L. Fitterer Inc License#:MSD410 <br /> (first,middle, last) <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 manufactured structure or my interest in it. The information listed is true to the best of my knowledge and <br /> belief,and I understaplitiR3,r used as evidence in court and is subject to a penalty of perjury. <br /> Signature: gutatAAAA, 1&., rtos Date: 4/15/2026 <br /> SECTION 5 •-37305344A138e4FD... HOME LOCATION <br /> Current Address:4995 Sunnyside Rd SE Site W21 <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 /> ❑This home is being moved to a new location Complete the section below <br /> };,[e=3ddress: <br /> City: County: State: Zip: <br /> Park Name: (if applicable) ❑This is a dealer lot or storage facility <br /> Transporter Name:Dougs Mobile Home Service Inc Phone: 5037990539 <br /> Address:12692 Fry Rd NE City: Aurora State: Oregon <br /> Email:dugwalton@aol.com <br /> Page 2 <br />