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, , <br /> co 4 5)--- LanJs no( t_h kJ) L--" <br /> NATURE OF FILING (check all that applies) <br /> ❑Change security interest 0 Change ownership ❑Demolition Date of demolition: <br /> ❑Recording as real property ❑Removing from real property status 0 Trip permit ❑ Converted to storage <br /> ❑Other: <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) (op`6 it )— <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:2022 <br /> Manufacturer serial number HUD number <br /> PHH3100R21-14651A ORE 555995 <br /> PHH3100R21-14651B ORE 555996 <br /> *Number of sections:2 • *Square footage:2280 *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:09/08/2021 *Sales price:$149,829.00 *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. <br /> Dealer name(print): Dea er s'gnaa .e:j' 4(triii4 Date: <br /> HOMES DIRECT OF OREGON LLC MILLERSBURG a4--' " ' s Drr lIF ////e0 <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 />