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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: C f'5,- $�., \_ - ADDRESS: 3737 Palm Harbor Drive,Millersburg,OR 97321. • Address:' \' tD ix...? PC-I �=Qr'r,a� Y-nr 4, j5 -c>'F`621ci and certifies that the home is new and has not been reg 'is in t '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 n , the property of said MANUFACTURER,has been transferred �� - .v this 12th dayof December 2024 on Invoice No 202487893100 Transferor(FirmName) / ere Pot n Dealer License(Permit)No. j ��// Before me personally appeared C .es+ `--s 1.4..— who by me being To: COMMONWEALTH HOMEOWNER SERVICES, INC. duly sworn upon oath says that the statements set forth above are t't and correct. Distributor,Dealer,Etc. a this day of '� �Q� `T� OFFICIAL STAMP Notary 'ublic for ... ra‘..v�4A•c� County,State of l�ay c+1 'fit. �gpooK Whose Address is: 18150 SW BOONES FERRY ROAD r?� NOTARY PUBLIC OREGON SECOND ASSIGNMENT Street ""': ►t( 91SS ON No.1014450 �ta O p� u t ed herebytransfers this Statement of Origin and the manufactured PORTLAND,OR 97224 a MY COMMIS '' 8 g g 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 wan-ants 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: PHH3100R24-16223E 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 a f ( orporation Transferor(Firm Name) Bya: t Sign Here Position • Dealer License(Peit).No. By: / rm 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&State) Notary Seal