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<br /> 0 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
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<br /> Home ID number(if known): DMV X-plate number(if known):
<br /> NEW 3 q���� 5 •
<br /> ❑Moving in from another state
<br /> Has no home ID or X-plate because: n Coming out of county deed records
<br /> Q Other:NEW HOME
<br /> Manufacturer:PALM HARBOR HOMES Model:3104G28563B Year:2019
<br /> Manufacturer serial number • HUD number •
<br /> •
<br /> PHH3100R18-13048A ORE544388
<br /> PHH3100R18-13048B ORE544389
<br /> *Number of sections:2 *Square footage: 1660 *Number of bedrooms:3 *Number of bathrooms:2
<br /> *Type of roofing:ARCH. *Type of siding:LAP CEMENT *Heating:ELECTRIC *Cooling:NONE
<br /> *Date of sale:12/17/2018 *Sales price:126,878.00 *Includes land: ❑Yes 0 No
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<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 /> 0 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.
<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 /0) 11)
<br /> 01/30/2019
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<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
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