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g- a83D, <br /> SECTION 1 NATURE OF FILING(check all that apply) <br /> El New home to MHODS ItIknaiekaittOyaerovilor t]/196kc item bte: ) <br /> 1�/ rltorZr a''shle d.to-s cage <br /> '01.41/4t sit r sfkl Ne OUVadlefrolaalkitts ❑i Trip Pemut <br /> SECTION 2 APPLICANT INFORMATION(please print) <br /> ❑Dealer/Seller ❑Lender ❑Escrow/Fitle Agent ❑Owner/Buyer ❑Legal Representative <br /> Name:HOMES DIRECT OF OREGON LLC Phone:541-928-2083 <br /> (first,middle,last) <br /> Address:3838 PALM HARBOR DR NE <br /> City:MILLERSBURG State:OR ZIP:97321 <br /> Email:TANYA.ABADILLA@HOMES.DI RECT <br /> SECTION 3 HOME INFORMATION(information in bold is required) <br /> Home ID#: n I E\A/ OR No Home ID: Q New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:PALM HARBOR (Q 0 B 5 9 <br /> Mode1:310AF14602A Year: 2024 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> PHH3100R23-15788A ORE 562697 <br /> #of Sections: 1 Sq.footage: 846 Bedrooms: 2 Bathrooms: 2 <br /> Roofing type: ARCH Siding type: FIBER CEM Heating type: ELEC Cooling type: NONE <br /> Date of sale: 12/19/2023 Sale price: 105152.00 Includes land: ['Yes ❑i No <br /> of applicable) <br /> SECTION 4 DEALER INFORMATION(leave blank if no dealer) <br /> Name:HOMES DIRECT OF OREGON LLC License#:MSD 523 <br /> (first,middle,last) <br /> Address:3838 PALM HARBOR DR NE <br /> City:MILLERSBURG State:OR ZIP:97321 . <br /> Email:TANYA.ABADILLA@HOMES.DI RECT Phone:541-928-2083 <br /> I hereby declare 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 or my interest in it. The information listed is true to the best of my knowledge and <br /> belief,and I understa d it can be used evidences ourt and is subject to a penalty of perjury. <br /> Signature: Date: // //9-174 <br /> SECTION 5 HOME LOCATION <br /> Current Address:3838 PALM HARBOR DR NE <br /> City:MILLERSBURG County:LINN State:OR Zip:97321 <br /> Park Name: (if applicable) %This is a dealer lot or storage facility <br /> 0 This home is being moved to a new location Complete the section below <br /> New Address:22832 RIVER RD NE <br /> City: SAINT PAUL County:MARION State:OR Zip:97137 <br /> Park Name: (if applicable) ❑This is a dealer lot or storage facility <br /> Transporter Name:BEN N ETT TRUCKING & TRANSPORT Phone: 541-879-3444 <br /> Address:409 BIGHAM BROWN RD City: EAGLE PT State: OR 97524 <br /> Email:YOR@BENNETTIG.COM <br /> Page 2 <br />