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e <br /> Dr.DrScJ : 97O5 <br /> SECTION.1 NATURE OF FILING (check all that apply) <br /> ❑■ New home to MHODS n e wner a 'o tfe: ) <br /> UNLYSgratiarfiNsOe Ifrikestfiliiagnszeivotavty ve o srage - <br /> \0"—Seenty,,itikesehange e m e tams. [11 Trip Permit. -. <br /> a ferN iai>e,titance <br /> SECTION`2'' APPLICANT INFORMATION (please print) ;t • <br /> 0 Dealer/Seller ❑Lender ❑Escrow/Title Agent ❑Owner/Buyer ❑Legal Representative <br /> Name:HOMES DIRECT OF OREGON LLC Phone:541-928-2083 <br /> Urst,middle,last) <br /> Address:3838 PALM HARBOR DR NE <br /> City:MILLERSBURG State:OR ZIP:97321 <br /> Email:TANYA.ABADILLA@HOMES.DIRECT <br /> SECTION 3 HOME INFORMATION (information in bold is required) " <br /> Home ID#:NEW OR No Home ID: ❑® New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:PALM HARBOR r 9 ff 2 <br /> Model:310HD28603C Year:2025 <br /> Serial Number(s) HUD Label Number(s) *Required if new home . - <br /> CAV3100R25-16442A ORE 567325 - <br /> CAV3100R25-16442E ORE 567326 <br /> #of Sections: 2 Sq.footage: 1620 Bedrooms: 3 Bathrooms: 2 - <br /> Roofmg type: ARCH Siding type: FIBER CEM Heating type: ELECTRIC Cooling type: NONE <br /> Date of sale: 06/12/2025 Sale price: 169,193.00 Includes land: ❑Yes ❑® No <br /> Qfapplicable) <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.DIRECT 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 understand it can be us as eviden e' ourt and is subject to a penalty of perjury. / / <br /> Signa re: � Date: �. �S <br /> SECTION '° ° ; 'HOME LOCATION <br /> Current Address:3838 PALM HARBOR DR NE <br /> City:MILLERSBURG County:LINN State:OR Zip:97321 <br /> Park Name: (f applicable) It This is a dealer lot or storage facility <br /> ®❑This home is being moved to a new location Complete the section below <br /> New Address:7729 LAKESIDE DR NE <br /> City:SALEM County:MARION State:OR Zip:97305 <br /> Park Name: (if applicable) ❑This is a dealer lot or storage facility <br /> Transporter Name: BENNETT 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 />