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. <br /> `-aCCD Meder SI- . S , DeA-r-04- <br /> _ <br /> SECTION 1 • NATURE OF FILING(check all that apply) <br /> 1:1 New home to MHODS [V\tidalingloreatoGg‘boddwfier g\DaelltienrOate: l <br /> 121\tibealeidtM Itrtta;trAgetftallittytEcy groDulatiSau-swirage <br /> NaNirathValAndlimge I ga~tigitrtfiNalladrysay-status 0 Trip Permit <br /> Viskattilafigkiaritance r51--'etbAvigasol1ate): <br /> SECTION 2 APPLICANT INFORMATION(please print) . <br /> f:Dealer/Seller 0 Lender 0 Escrow/Title Agent El Owner/Buyer 0 Legal Representative <br /> Name:llimi.middllast)Cascade Factory Homes, Inc Phone:503-981-5314 <br /> e. <br /> Address:590 N Pacific Hwy <br /> city:Woodburn State:OR i EP:97071 <br /> Email:cascadehomes@yahoo.com <br /> SECTION 3 , HOME INFORMATION(information in bold is required) <br /> • <br /> Home ID#: OR No Home ID: El New Home 0 Out of state home 1=1Leavmg County Deed Records <br /> • Manufacturer Palm Harbor Homes f, 0 9 5 a 3. <br /> Model:301AF14562A Year:2024 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> PHH3100R23-15853A ORE 563022 <br /> #of Sections: 1' Sq.footage 756 Bedrooms: 2 Bathrooms: 1 <br /> Roofing type: Arch Shingles Siding type: Cement , Heating type: Elect Cooling type: N/A ' <br /> Dat"f sale' 4/23/24 saieprice: 87,168 Includes land: 0 Yes E No <br /> (Ifapplimbh9 <br /> ,SECTION,,N, 4am, es:Cascade <br /> DEALER INFORMATION(leave blank if no dealer) <br /> Factory Homes, Inc I License it MSD-41 <br /> airs!,mi.u.,...gm, • <br /> Address:590 N Pacific Hwy <br /> ' . <br /> City:Woodburn state:OR ZIP:97071 <br /> Email:cascadehomes@yahoo.com Phone:503-981-5314 <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 6nufactured structure or my interest in it.The information listed is true to the best of my knowledge and <br /> belief,and I understan •it c n be used as evidence in court and is subject to a penalty of perjury.. <br /> Signaturp , C\:PILT-1----- I Date: i JOAO:3(r9 <br /> SECTION 5 HOME LOCATION i <br /> Current Address:590 N Pacific Hwy <br /> City:Woodburn I County:Marion I State:OR Zip:97071 <br /> Park Name:(if applicable) [Si This is a dealer lot or storage facility <br /> , . <br /> 0 This home is being moved to a new location Complete the section below <br /> New Address:200 Meyer St <br /> City:Detroit County:Marion I State:OR 1 Zip:97342 <br /> Park Name:(if applicable) 0 This is a dealer lot or storage facility <br /> Transporter Name:Superior Home Transport LLC Phone: 541-327-7805 <br /> Address:PO Box 1067 City: Jefferson State: OR <br /> Email:ritahartzell@gmall.cOm <br /> Page 2 <br />