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-6351 R0 -3-; r5©n ci -7 3 5 <br /> NATURE'OF FILING.(check all that applies) <br /> an e ur' i t * Change ownership rtr c of o • . <br /> cot ' a • p s El Trip permit kcdU-Sthoge <br /> ❑Ct*r: <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 (*req'uired) <br /> Home ID number(if known): DMV X-plate number(if known): <br /> NEW C003(03 <br /> ❑ Moving in from another state ("h 5 3(c3cii) <br /> • Has no home ID or X-plate because: ❑ Corning out of county deed records <br /> ❑Other: <br /> Manufacturer:PALM HARBOR Mode1:310HD30633F Year:2023 <br /> Manufacturer serial number HUD number <br /> PHH3100R22-15158A ORE 559424 <br /> PHH3100R22-15158B ORE 559425 <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: 9/2/2022 *Sales price:163,391.00 *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): 1 r signatur : Date: <br /> HOMES DIRECT OF OREGON LLC MILLERSBUR / /4/ " <br /> 1 <br /> TRANSPORTER INFORMATI N (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(7/191COM) Page 2 <br />