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• <br /> 553 \ unceS- : NI SciAexy, 9/ 0 <br /> NATURE OF FILING (check all that applies) <br /> Eitekykshauitiputtst ■❑ Change ownership D it' n lD46 off. �/1✓ <br /> `cjItiNrs n s,rklio'vat , 0 1 r r o rt a s Trip permit Qo t ljkiage <br /> 13.1,9ther: <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 <br /> I Moving in from another state CS 1$ j vd'. <br /> Has no home ID or X-plate because: Corning out of county deed records <br /> n Other: <br /> Manufacturer: PALM HARBOR Model:3104G28562A Year: 2023 <br /> Manufacturer serial number HUD number <br /> PHH3100R22-15316A ORE 560425 <br /> PHH3100R22-15316B ORE 560426 <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: 12/28/2022 *Sales price: $184,665.00 *Includes land: ❑Yes El 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): Dealer signature: Date: <br /> HOMES DIRECT OF OREGON LLC MILLERSBURG <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/CONt) Page 2 <br />