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`D:DN 105 3.-enn;e RA ct-13,58 1p <br /> 4'Y+ �'"S i { j� , ,��- �NATUR��OIy�FgILING�(check�a(I that�ap � . : <br /> - _ <br /> ❑ co <br /> Change security interest ❑ Change ownership [❑ Demolition Date of demolition: ,did,,,,, <br /> ❑Recording as real property ❑ Removing from real property status O Trip permit ❑Converted to storage <br /> ❑ Other: <br /> °,'' ` � ` f{ '' f 't4PPL�G/1NTINIFORMATI0�1 � � <br /> O Dealer/seller ❑ Lender ❑ Escrow/title agent ❑ Owner/buyer ❑ Legal representative <br /> Name:HOMES DIRECT OF OREGON <br /> Address(including city,state, and ZIP):3838 PALM HARBOR DR NE, MILLERSBURG, OR 97321 <br /> Phone:541-928-2083 <br /> Email:neilaw31@gmail.com <br /> � tr Q`�tt,.M fi- ;.� ,, .n.,zr� t ;= ..., �,. .�,..__. a�tcw�.i-dam^.u•o`aCafaar.,o`er,... e-a��_ ..._. -.r . <br /> Home ID number(if known): DMV X-plate number(if known): <br /> NEW M 35(0 44 <br /> ❑ Moving in from another state <br /> 1-las no home ID or X-plate because: ❑Coming out of county deed records <br /> Q Other:NEW HOME <br /> Manufacturer:PALM HARBOR HOMES Model:3104G28562A Year:2019 <br /> Manufacturer sen ml number HUD'nwnber <br /> PHH3100R18-12972A ORE543166 <br /> PHH3100R18-12972B ORE543167 <br /> *Number of sections:2 *Square footage: 1552 *Number of bedrooms:2 *Number of bathrooms:2 <br /> *Type of roofing:COMP. *Type of siding:VERT.CEM ENT *Heating:ELECTRIC *Cooling:NONE <br /> *Date of sale:09/27/2018 *Sales price:$117,988.00 *Includes land: ❑Yes No <br /> NFOf�ATI4f Z.:.di 4 ry{ i-. ! c i�i., '� {•.u+ 47 Y SE.: '' P ' +v s t t * 3{�4 }. y '°r t%.f iCy ti z': <br /> iDE�LER�� <br /> Dealer name: Dealer license number: Dealer address and phone: <br /> HOMES DIRECT OF OREGON MSD523 3838 PALM HARBOR DR NE <br /> MILLERSBURG, OR 97321 <br /> 541-928-2083 <br /> OThis 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. <br /> I hereby declare that the above statement is true to the best of my knowledge and belief,and that I understand it is <br /> made for use as evidence in court and is subject to penalty for perjury. <br /> Dealer name (print): Dealer signature: Date: <br /> NEILA WHITE / 10/5/2018 <br /> TRANSPORTER`I FORMATIO (tf not rnoYvingIje,4Ve)blank) 4-?• l <br /> Transporter name: Transporter address and phone: <br /> BENNETT TRUCK TRANSPORT PO BOX 503098 <br /> WHITE CITY, OR 97503 541-879-3444 <br /> 440.2952(7/17/COM) Page 2 <br />