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\ 13 9 Whe.ct.-rand Rd 61e_ru S <br /> NATURE OF FILING (check all that applies) <br /> IN i g se t-r-,t l 'h.. :e .,.- er.1' D oli ' t1Ap too e 1' ' <br /> or ' g s a op rty e o 'ng r t• e.a m r tat ■❑Trip permit - • c i <br /> her: <br /> APPLICANT INFORMATION <br /> Dealer/seller ❑ Lender ❑ Escrow/title agent ❑ Owner/buyer ❑ Legal representative <br /> Name:HOMES DIRECT OF OREGON LLC MILLERSBURG <br /> Address(including city,state,and ZIP):3838 PALM HARBOR DR MILLERSBURG OR 97321 <br /> Phone:541-928-2083 <br /> Email:TANYA.ABADILLA@HOMES.DIRECT <br /> HOME INFORMATION (*required) <br /> Home ID number(if known): DMV X-plate number(rf known): p /�� <br /> NEW 5 / 1 <br /> ❑ 5 <br /> Moving in from another state Co " t q 41 <br /> Has no home ID or X-plate because: ❑ Corning out of county deed records <br /> ❑ Other: <br /> Manufacturer:PALM HARBOR Model:310HD30633f Year:2021 <br /> Manufacturer serial number HUD number <br /> PHH3100R20-13987A ORE 552438 <br /> PHH3100R20-139876 ORE 552439 <br /> *Number of sections:2 *Square footage:1880 *Number of bedrooms:3 *Number of bathrooms:2 <br /> *Type of roofing:ARCH *Type of siding:FIBER CEM *Heating:ELECTRIC *Cooling:NONE • <br /> *Date of sale:06/10/2020 *Sales price:$119,290.00 *Includes land: ❑ Yes El No <br /> DEALER INFORMATION (if no dealer, leave blank) <br /> Dealer name: Dealer license number: Dealer address and phone: <br /> HOMES DIRECT OF OREGON LLC MSD-523 3838 PALM HARBOR DRIVE NE <br /> MILLERSBURG MILLERSBURG OREGON 97321 <br /> 541-928-2083 <br /> El 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. <br /> I hereby declare that the above statement is true to the best of my knowledge and belief,and that I understand it is <br /> made for use as evidence in court and is subject to penalty for perjur . <br /> Dealer name (print): Dealer si:nat . Date: <br /> HOMES DIRECT OF OREGON LLC MILLERSBURG 6640(-1,4; eel c_ /g-/ <br /> TRANSPORTER INFORMATION (if not moving, leave blank) <br /> Transporter name: Transporter address and phone: <br /> • <br /> BENNETT TRUCKING&TRANSPORT 409 BIGHAM BROWN RD <br /> JACKIE YOUNG EAGLE PT OREGON 97524 <br /> 541-879-3444 JACKIE YOUNG <br /> 440-2952(7/19/COM) Page 2 <br />