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625 5 s h St 8 <br /> r Sctletyl i <br /> NATURE OF FILING (check all that applies) <br /> ESAatiNvAptfaiLy.iftterest El Change ownership tin t o t ' . <br /> 51- f i s pl r ty p stacfris ■❑Trip permit Uteri rerU orage <br /> tQlOfher: <br /> APPLICANT INFORMATION <br /> 0 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 b S6 Co <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 Mode1:310AF15762R Year: 2024 <br /> Manufacturer serial number HUD number <br /> PHH3100R23-15639A ORE 562212 <br /> *Number of sections: 1 *Square footage:1140 *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: 7/19/2023 *Sales 139 120.00 S lesprice: $ Includes land: Yes ■ <br /> ❑ ❑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 signature: , Date: <br /> HOMES DIRECT OF OREGON LLC MILLERSBU �7/, <br /> TRANSPORTER INFORMATIO (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 />