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3 1 0 )_a ke_ore_51- DR Ose-- oi -13 4 <br /> NATURE OF FILING (check all that applies) <br /> rT s. -s J Change ownership i t' iafkio1 i ioitiv 111""-- <br /> r ' a e. p op; R:- •• ' g r• i ••-• sta s ■❑Trip permit G�d11.6(l <br /> L C ther: <br /> APPLICANT INFORMATION <br /> El 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 Coo07 `I 6 <br /> ElMoving in from another state C S `d 4 4 E <br /> Has no home ID or X-plate because: ❑Coming out of county deed records <br /> ❑Other: <br /> Manufacturer:PALM HARBOR Model:3104G28362A Year:2022 <br /> Manufacturer serial number HUD number <br /> PHH3100R21-14760A ORE 556770 <br /> PHH3100R21-14760B ORE 556771 <br /> *Number of sections: 2 *Square footage:972 *Number of bedrooms: 1 *Number of bathrooms: 1 <br /> *Type of roofing:ARCH *Type of siding:FIBER CEM *Heating:ELECTRIC *Cooling:NONE <br /> *Date of sale: 12/2/2021 *Sales price:$105,772.00 *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 /> 3� <br /> Dealer name(print): Deale sig .tu ••!y /ateifre–i:3 Date: <br /> HOMES DIRECT OF OREGON LLC MILLERSBURG Sijieei:e117,' 33//Co/aa— <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 />