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- • 8 306 sem. 5 , � '0I �I- Sas _ _ <br /> NATURE OF FILING (check all that applies) <br /> C ge In t t [' Change ownership [i,, it r\D: e • d e . i ,-: <br /> _ 'et, di .s r-. •ro - i♦ 'e••.v _ -a • .sr. atus El Trip permit v to t rat <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(if known): <br /> NEW <br /> ❑Moving in from another state <br /> Has no home ID or X-plate because: ❑ Coming out of county deed records <br /> ❑ Other: • <br /> Manufacturer:PALM HARBOR Model:310HD30763A Year:2021 <br /> Manufacturer serial number HUD number <br /> PHH3100R21-14499A ORE 555033 <br /> PHH3100R21-14499B ORE 555034 <br /> *Number of sections:2 *Square footage:2160 *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:5/7/21 *Sales price:$141,119.00 *Includes land: ❑ Yes 0 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 /> *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 perjury. a % <br /> Dealer name (print): Dealer si:nat e:' Date: <br /> HOMES DIRECT OF OREGON LLC MILLERSBURG GN .4' // /OA 79-7 <br /> i;/1(.1j3i <br /> TRANSPORTER INFORMATION (if not moving, leave blank) <br /> Transporter name: Transporter address and phone: <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 />