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-59 D1 4,11-eN/ Vet-ui luE vel-on <br /> NATURE OF FILING (check all that applies) <br /> e uri re t El Change ownership e li ' at of mo ' ion: <br /> `[ $ c 'di as 1 p m a op t El Trip permit v e e <br /> cQptL-ier: <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): 2 1 <br /> NEW 603 <br /> El Moving in from another state S ii 3 <br /> -Has no home ID or X-plate because: ❑Coming out of county deed records . <br /> ❑Other: <br /> Manufacturer: PALM HARBOR Mode1:310HD28523R Year: 2023 <br /> Manufacturer serial number HUD number . <br /> PHH3100R22-15309A ORE 560416 <br /> PHH3100R22-15309B ORE 560417 <br /> • <br /> *Number of sections: 2 *Square footage:1476 *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: 12/29/2022 *Sales price: $175,246.50 *Includes land: ❑ Yes ■❑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): De e signature: Date: <br /> HOMES DIRECT OF OREGON LLC MILLERSBURG /A/ a4P-7/A <br /> TRANSPORTER INFORMATI (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 />