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600520
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Last modified
1/13/2022 5:59:52 AM
Creation date
3/10/2021 3:36:01 PM
Metadata
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Template:
Assessor
Account Number
600520
Assessor Doc Type
Trip Permit
Secondary Assessor Doc Type
Jacket
Doc Type Date
2/17/2021
MTL
032W310000100
Assessor Section
Manufactured Structures
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MANUFACTURER'S STATEMENT OR CERTIFICATE OF ORIGIN TO A MANUFACTURED HOME tl , - <br /> FIRST ASSIGNMENT <br /> MANUFACTURER: Palm Harbor Homes For Value Received,the undersigned hereby transfers this Statement of Origin and the manufactured <br /> home described therein to: <br /> ADDRESS: 3737 Palm Harbor Drive,Millersburg,OR 97321 Address: <br /> and certifies that the home is new and has not been registered in this or any other state:he also warrants <br /> Street.City.State,and Zip the title of said home at time of delivery,subject to the liens and encumbrances,if any,as set out below <br /> Amt.Of Lien Date To Whom Due Address <br /> The undersigned MANUFACTURER hereby certifies that the new manufactured home described below. Dated at <br /> the property of said MANUFACTURER.has been transferred By. <br /> this 24th day of March . 2020 on Invoice No 201938374400Dealer License(Permit)NoTranror(Firm meJ) Sign Here Position <br /> Before me personally appeared who by me being <br /> To: HOMES DIRECT OF OREGON,LLC. duly sworn upon oath says that the statements set forth above are true and correct. <br /> !)Gull>tttor.Dealer,Etc Notary <br /> and sworn to before me this day of <br /> Notary Public for County,State of <br /> Whose Address is: 3838 PALM HARBOR DRIVE Nntaty Seal <br /> SECOND ASSIGNMENT <br /> Street For Value Received,the undersigned hereby transfers this Statement of Origin and the manufactured <br /> MILLERSBURG,OR 97321 home described therein to: <br /> City.State,and Zip Address: <br /> and certifies that the home is new and has not been registered in this or any other state:he also warrants <br /> Trade Name: 310HD-Homes Direct-30633F Model Year: 2020 the title of said home at time of delivery,subject to the liens and encumbrances,if any,as set out below <br /> Amt.Of Lien Date To Whom Due Address <br /> Model No: 310HD30633F Body Width Ft: 30'0" <br /> Body Length Ft: 80'0" /Ft: 76'0" Dated at <br /> • By: <br /> Including Hitch Excluding Hitch <br /> Transferor(Firm Name) Sign Here Position <br /> Square Feet: 2280 Date of Manufacture: 03/16/2020 Dealer License(Permit)No. <br /> Before me personally appeared who by me being <br /> Manufacturer's ID No: PHH3100R20 13871A-AC Weight: 33.396 duly sworn upon oath says that the statements set forth above are true and correct. <br /> Subscribed and sworn to before me this day of <br /> Manufacturer's ID No: PHH3100R20-13871 B-AC Weight: 35.562 Notary Public for County,State of <br /> Manufacturer's ID No: Weight: Notary Seal <br /> THIRD ASSIGNMENT <br /> Manufacturer's ID No: Weight: For Value Received,the undersigned hereby transfers this Statement of Origin and the manufactured <br /> Manufacturer's ID No: Weight: home described therein to: <br /> Manufacturer's ID No: Weight: Address: <br /> • <br /> and certifies that the home is new and has not been registered in this or any other state:he also warrants <br /> the title of said home at time of delivery,subject to the liens and encumbrances,if any,as set out below <br /> 'fhe CORPORATION further Certifies that this was the first transfer of such new manufactured home in Amt.Of Lien Date To Whom Due Address <br /> ordinary trade and commerce. <br /> Palm Harbor Ho A. _ Dated at <br /> By. <br /> � �� fair_AP.z,&- Transfror Name) Sign Hrrc Parltfan <br /> Deafer License(Permit)No. <br /> By: <br /> �iTore me personally appeared who by me being <br /> Sign Name Dile or Position duly sworn upon oath says that the statements set forth above are true and correct. <br /> 3737 Palm Harbor Drive,Millersburg, OR 97321 Subscribed and sworn to before me this day of <br /> Notary Public for County,State of <br /> Office Address o/Signoloiy(City&State) Norure Seal <br />
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