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8305 t/ i 'l oy n RA Si Lyons 735 , <br /> NATURE OF FILING (check all that applies) <br /> ❑tthgvn est ❑■ Change ownership L_hU• e • . P.to : le •e ti• <br /> ❑� <br /> ` 3 e erty L ' - 01 g o , re.. oro.• at U]Trip permit a s e <br /> aien— <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): p� `,�C %'1 <br /> NEW ( c o-v/ <br /> ❑Moving in from another state <br /> Has no home ID or X-plate because: ❑ Coming out of county deed records <br /> n Other: <br /> Manufacturer:PALM HARBOR Model:310HD30633A Year:2022 <br /> Manufacturer serial number HUD number <br /> PHH3100R21-14664A ORE 556009 <br /> PHH3100R21-14664B ORE 556010 <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:08/06/2021 *Sales price:$139,937.00 *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 perjur . <br /> Dealer name (print): Deal r si nat ��' l J es Date: <br /> HOMES DIRECT OF OREGON LLC MILLERSBURG VIYte 'o /0/4",* <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 />