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bac s a�-�-� �' - • 1► w SE6,_-,L5734c <br /> . gyp\ <br /> NATURE OF FILING (check all that applies) <br /> rig : _- e, 1't--= t 0 Change ownership driN ee d n l' <br /> "N.&-c. 6' as o - ; 'e I r o st 0 Trip permit N- o , ed o or e <br /> NSAor: <br /> APPLICANT INFORMATION <br /> 0 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(f known): DMV X-plate number(if/mown):/ //�� lD`� <br /> NEW ecOUP <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:3104G28562A Year:2022 <br /> Manufacturer serial number HUD number <br /> PHH3100R21-14868A ORE 557576 <br /> PHH3100R21-14868B ORE 557577 <br /> *Number of sections: 2 *Square footage:1553 *Number of bedrooms: 2 *Number of bathrooms:2 <br /> *Type of roofing:ARCH *Type of siding:FIBER CEM *Heating:ELECTRIC *Cooling:NONE <br /> *Date of sale: 3/2/2022 *Sales price:$133,791.50 *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 /> 0 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. j <br /> Dealer name(print): Deal-r si tnatu ' Date: <br /> HOMES.DIRECT OF OREGON LLC MILLERSBURG6;,p a,„ e2/1# 7'�o <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 />