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IO ace WcLjY--e.-{ qc) S4L)(o 9 -73 u <br /> NATURE OF FILING (check all that applies) <br /> Krtvatike&M.ifilizsg, ❑■ Change ownership m ' io <br /> )c}Thepeki,artuakAvfty � I igv tbl�r us 0 Trip permit SLCAverke.g,tasjorage <br /> t her: <br /> • APPLICANT INFORMATION <br /> Li Dealer/seller ❑ Lender E 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 /> ❑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:310HD30763H Year: 2023 <br /> Manufacturer serial number HUD number <br /> PHH3100R22-15411A ORE 560889 <br /> PHH3100R22-15411 B ORE 560890 <br /> *Number of sections: 2 *Square footage:2213 *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: 3/2/2023 *Sales price: <br /> $234,842.00 *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): P:"It <br /> ; signati e: Date: <br /> HOMES DIRECT OF OREGON LLC MILLERSBUR TRANSPORTER INFORMAT 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 />