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Docusign Envelope ID:EDOCF123-F57F-4884-9BDE-574BA5E290CC 1 5 a b U i e R 1 I v e, ��n SECTION 1- _ .' .r NATURE.OF FILING (checkall_thata,a ) ❑■ New-home to MHODS ❑ Adding or removing a co-owner ❑ Demolition(Date: ) . • ❑ Used home:sale ❑ Recording as real property ❑ Converted to storage-. ,.. •• ❑ Security interest change ❑ Removing from real property status . ❑■ .Trip Permit ❑ Transfer by inheritance ❑ Other(please note): . SECTION 2, ,„' : APPLICANT.INFORMATION (please print) r. ;_ •., :r II Dealer/Seller ❑Lender ❑Escrow/Title Agent ❑Owner/Buyer ❑Legal Representative- :NaineHOMES DIRECT.OF OREGON LLC - Phone 541 928-2083 (first„middle,last) r Address:3838:PALM HARBOR DR NE . , T_ ` 'C ty:.MILLERSBURG State:OR - ZIP:97321 Email:TANYA.ABADILLA@HOMES.DIRECT - ... SECTION 3. HOME INFORMATION(information In bold is required).; , Home'ID#:_0-t W OR No Home ID: .0 New Home 0 Out of state home ❑Leaving County Deed Records..... . Manufacturer:PALM'HARBOR . . Model:3105G42744A . - . Year:2025 Serial Nuinber(s) HUD Label Number(s) *Required if new home ..PHH3100R25-16313A ORE 566322 ., . PHH3100R25-1631.3E ORE 566323 : • •. . PHH310OR25-16313C ORE 566324 • #.of Sections: :3. Sq:.footage: 2646 Bedrooms: 4 Bathrooms: 3 Roofing type: ARCHL:. . Siding type: LAP CEM• Heating type: ELECTRIC:; . • Cooling type: =NONE Date_gf,sale: 2/28/2025. .. Sale price: 287,966.00 Includes land: ❑Yes ':0No -., .--- al-applicable)" -. .._. ,;SECTION 4 . , „ DEALER INFORMATION (leave blank f.no.'dealer) - „, :Name:HOMES DIRECT OF OREGON LLC --- --- - - - License#:MSD-523-- -- - (first,middle,last). -. . - -"Address:3838_PALM HARBOR DR NE .. ". _ _ .-:City:MILLERSBURG State:OR " ZIP:97321.=; ..`. .- .. " " • Email:TANYA.ABADILLA@HOMES.DIRECT Phone:54.1-9;28�2083 I hereby declare this manufactured structure is free and clear of all mortgages,deeds of trust,security interests,and liens.I have the legal right-to sell this manufactured structure or my interest in it. The information listed is true to the best of my-knowledge-and-- belief,and I under t can be used evidence in 9}trt and is subject to a penalty of perjury. Signatur . Date: s//s 9S �-SECTION 5 ..,.y . ;,. .„ , :.`:HOME LOCATION 4 Current Address:3838 PALM HARBOR DR NE City:MILLERSBURG County:LINN State:OR Zip:97321 Park Name: (if applicable) This is a dealer lot or storage facility El This home is being moved to a new location Complete the section below New Address:15408 WIED RD SE • - City:JEFFERSON County:MARION State:OR - Zip:97352 Park Name: (if applicable) ❑This is a dealer lot or storage facility Transporter Name:BENNETT TRUCKING &TRANSPORT Phone: 541-879-3444 Address:409 BIGHAM BROWN RD City: EAGLE PT State: OR 97524 .. .- Email:YOR@BENNETTIG.COM Page 2