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k61. IQ s-1- Pc& <br /> NATURE OF FILING (check all that applies) <br /> CSIZOWA9zialtateitst ■❑Change ownership [pAa 't' 1 rt. • • - A ' - <br /> [V eactrin s r l r y I re •e i o' •. p •• • s . 0 Trip permit ®Co f9eLd .tdl•a <br /> [gO her: <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 140 b 3 6 1 q 9-NAA6 <br /> ❑Moving in from another state <br /> Has no home ID or X-plate because: n Coming out of county deed records <br /> [' Other: <br /> Manufacturer:PALM HARBOR Model:310HD30603D Year:2022 <br /> Manufacturer serial number MUD number <br /> PHH3100R21-14814A ORE 557166 <br /> PHH3100R21-14814B ORE 557167 <br /> *Number of sections: 2 *Square footage:1800 *Number of bedrooms: 3 *Number of bathrooms:2 <br /> *Type of roofing:ARCH *Type of siding:FIBER OEM *Heating:ELECTRIC *Cooling:NONE <br /> *Date of sale: 1/14/2022 *Sales price:$123,250.00 *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 /> El 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 /> 311,1114 <br /> Dealer name(print): Deal•r si•natu,-: �� /, /', Date: <br /> HOMES DIRECT OF OREGON LLC MILLERSBURG G� / .� J���/ <br /> o GGA a"ar <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/CONI) Page 2 <br />