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\ 50 m ; uCI <br /> y <br /> NATURE OF FILING (check all that applies) <br /> ❑Change security interest ❑ Change ownership ❑ Demolition Date of demolition: <br /> ❑ Recording as real property ❑ Removing from real property status ❑■ Trip permit ❑ Converted to storage <br /> ❑Other: <br /> APPLICANT INFORMATION <br /> ❑� 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 /> HOME INFORMATION (* required) <br /> Home ID number(ifloio inn): DMV X-plate number(if known): '\ <br /> NEW rr 3 5 8 9V <br /> ❑ Moving in from another state <br /> Has no home ID or X-plate because: C Coming out of county deed records <br /> LI Other: <br /> Manufacturer:PALM HARBOR Model:310HD30763A Year:2020 <br /> Manufacturer serial number HUD number <br /> PH H310OR 19-13644A O RE548931 <br /> PHH3100R19-13644B ORE548932 <br /> *Number of sections:2 *Square footage: 1917 *Number of bedrooms:2 *Number of bathrooms:2 <br /> *Type of roofing:.COMP. *Type of siding:VERT.CEMENT *Heating:ELECTRIC *Cooling:NONE <br /> *Date of sale: 11/01/2019 *Sales price:$141,578.00 *Includes land: ❑ Yes $1 No <br /> DEALER INFORMATION (if no dealer, leave blank) <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 /> 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 WHITE12/19/2019 <br /> TRANSPORTER INFORMATI (if not moving, leave blank) <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 />