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MANUFACTURER'S STATEMENT OR CERTIFICATE OF ORIGIN TO A MANUFACTURED HOME
<br /> FIRST ASSIGNMENT
<br /> MANUFACTURER:Palm Harbor Homes For Value Received,the undersigned hereby transfers this Statement of Origin and the manufactured
<br /> home described therein to: CRT_ C,,,.,,�„•,..() OA„tea r" ��0
<br /> ADDRESS: 3737 Palm Harbor Drive, Millersburg, OR 97321 Address: 1'1h S\r C o<,-a. C=er .4 41.., (ss'c\r Aap.. 1_ ".-- ''l a5-,i
<br /> and certifies that the home is new and has not been registrrried in this or any other state;he also warrants
<br /> 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
<br /> Amt.Of Lien Date To Whom Due Address
<br /> - — -
<br /> -i !,-• The undersigned MANUFACTURER hereby certifies that the new manufactured home described below, ��
<br /> Dated at pr //
<br /> the property of said MANUFACTURER,has been transferred cc �� .4\ �n�ti ,c ,>By_( „���- -
<br /> this 28th day of February 2025 on Invoice No 202492080000 Tnsferor(Firm Na
<br /> Dealer License(Permit)Nome).
<br /> .t -Sr> --, - .'�'Here Position
<br /> ..- .-... '-4., �. (�.n.�.,�.�-s...4".- who by me being
<br /> To: COMMONWEALTH HOMEOWNER SERVICES INC. ly swornQr4tIrMF'At the stat ents set forth above are true and correct.
<br /> C �; becribed tMEM S9c PPore me thi ��day of (\--rk,n.- a0c`�-
<br /> Distributor,Dealer,Etc. T
<br /> i �� NOTARY PUBLIC-Q li.for \, A.r,, County,State of C t..o�.r..
<br /> r':� Km"'i .~r• ••.101 45
<br /> Whose Address is: 18150 SW BOONES FERRY ROAD MY r OMMISSION EXPIRES JULY 08,2025
<br /> COND ASSIGNMENT
<br /> Street For Value Received,the undersigned hereby transfers this Statement of Origin and the manufactured
<br /> PORTLAND,OR 97224 home described therein to:
<br /> City,State,and Zip Address:
<br /> and certifies that the home is new and has not been registered in this or any other state;he also warrants
<br /> Trade Name: 3104G-400-28441A • Model Year: 2025 the title of said home at time of delivery,subject to the liens and encumbrances,if any,as set out below
<br /> Amt.Of Lien Date To Whom Due Address
<br /> Model No: 3104G28441A Body Width Ft: 27'0"
<br /> Body Length Ft: 57'8" /Ft: 53'8" Dated , at
<br /> By:
<br /> Including Hitch Excluding Hitch
<br /> Transferor(Firm Name) Sign Here Position
<br /> Square Feet: 1220 Date of Manufacture: 02/27/2025 Dealer License(Permit)No.
<br /> Before me personally appeared who by me being
<br /> duly sworn upon oath says that the statements set forth above are true and correct.
<br /> Manufacturer's ID No: PHH3100R25-16316A Weight: 19,680. ' Subscribed and sworn to before me this day of
<br /> Manufacturer's ID No: PHH3100R25-16316E Weight: 21,048 Notary Public for. County,State of
<br /> Manufacturer's ID No: Weight: Notary Seal
<br /> THIRD ASSIGNMENT
<br /> Manufacturer's ID No: Weight: For Value Received,the undersigned hereby transfers this Statement of Origin and the manufactured
<br /> Manufacturer's ID No: Weight:. home described therein to: •
<br /> Manufacturer's ID No: Weight: Address:
<br /> and certifies that the home is new and has not been registered in this or any other state;he also warrants
<br /> the title of said home at time of delivery,subject to the liens and encumbrances,if any,as set out below
<br /> The CORPORATION further Certifies that this was the first transfer of such new manufactured home in Amt.Of Lien Date To Whom Due_ Address
<br /> ordinary trade and commerce.
<br /> Palm Harbor es /1 Dated at
<br /> By:
<br /> JCorporntior ( )
<br /> !/ire /JL_�}j Transferor(Firm Name) Sign Here Positron
<br /> Dealer License Permit No.
<br /> By: 0.. ----jh Before me personally appeared who by me being
<br /> Sign Name Title or Position duly sworn upon oath says that the statements set forth above are true and correct.
<br /> 3737 Palm Harbor Drive,Millersburg,OR 97321 Subscribed and sworn to before me this day of ,
<br /> Notary Public for County,State of
<br /> Office Address of Signatory(City&State)
<br /> Notary Seal
<br />
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