607366 - Laserfiche WebLink

Home Browse Search

MANUFACTURER'S STATEMENT OR CERTIFICATE OF ORIGIN TO A MANUFACTURED HOME •' FIRST ASSIGNMENT . MANUFACTURER:Palm Harbor Homes For Value Received,the undersigned hereby transfers this Statement of Origin and the manufactured • home described therein to: (R,� $$ (- \ _ ADDRESS: 3737 Palm Harbor Drive,Millersburg,OR 9732.1. Address:\IM-ID `�'- po°' c s ��f_r �r IL_C—r( Yty and certifies that the home is new and has not been regis int 's or any other state;he also warrants Street,City,State,and Zip the title of said home at time of delivery,subject to the liens and encumbrances,if any,as set out below Amt.Of Lien Date To Whom Due -Address The undersigned MANUFACTURER hereby certifies that the new manufactured home described below, Dated !'l , '� at /1_// .// the property of said MANUFACTURER,has been transferred + ( v this 12th dayof December 2024 on Invoice No 202487893100 Transferor(Firm Name) /Sign Here Posih n Dealer License(Permit)No. / Before me personally appeared C�n+R. i t, , who by me being To: COMMONWEALTH HOMEOWNER SERVICES, INC. duly sworn upon oath says that the statements set forth above are tSolr and correct. Distributor,Dealer,Etc. a this ____0,_day of , �Q� 4°r�4 OFFICIAL STOP P Notary.'ublic for L....a�.wrls County,State of �tt�.N Whose Address is: 18150 SW BOONES FERRY ROAD 5 NOTARY PUBLIC-OREGON SECOND ASSIGNMENT < Street \5 O !SS ON NO.1014450 yt.[,ugig ed hereby transfers this Statement of Origin and the manufactured PORTLAND,OR 97224 i MY COMMIS City,State,and Zip Address: . and certifies that the home is new and has not been registered in this or any other state;he also warrants Trade Name: 3104G-400-24523A Model Year. 2025 the title of said home at time of delivery,subject to the liens and encumbrances,if any,as set out below Amt.Of Lien Date To Whom Due Address Model No: 3104G24523A • Body Width Ft: 23'4" Body Length Ft: 56'0" /Ft: 52'0" Dated at By: Including Hitch Excluding Hitch Transferor(Firm Name) Sign Here Position Square Feet: 1167 Date of Manufacture: 12/11/2024 Dealer License(Permit)No. Before me personally appeared . who by me being duly sworn upon oath says that the statements set forth above are true and correct. Manufacturer's ID No: PHH310OR24-16223A , Weight: 20,940 Subscribed and sworn to before me this day of , Manufacturer's ID No: PHH310OR24-16223B Weight: 21,408 Notary Public for County,State of Manufacturer's ID No: Weight: Notary Seal • THIRD ASSIGNMENT Manufacturer's ID No: Weight: For Value Received,the undersigned hereby transfers this Statement of Origin and the manufactured' Manufacturer's ID No: Weight: home described therein to: • Manufacturer's ID No: Weight: . . . . Address:. and certifies that the home is new and has not been registered in this.or any other state;he also warrants the title of said home at time of delivery,subject to the liens and encumbrances,if any,as set out below The CORPORATION further Certifies that this was the first transfer of such new manufactured home in Amt.Of Lien Date To Whom Due Address ordinary trade and commerce. Palm Harbor es Dated at • By: orpora[ion Transferor(Finn Name) Here f Sign Position Dealer License(Permit).No. By:. Before me personally appeared who by me being Sign Name Title or Position duly sworn upon oath says that the statements set forth above are true and correct. 3737 Palm Harbor Drive, Millersburg,OR 97321 Subscribed and sworn to before me this day of , Notary Public for County,State of Office Address of Signatory(City&Stale) Notary Seal