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3785lrNE S, lI <br /> vev <br /> � <br /> 1-00 <br /> NATURE OF FILING (check all that applies) <br /> adkb n cu .t i t 11�st ❑■ Change ownership ■ : ,: io- !.to • eels io : <br /> Vimslifigul'eglyaroper.1y /grkeyTro\ippekyAnus Ei Trip permit Li4Aptaisallopg, <br /> E, Nther: <br /> APPLICANT INFORMATION <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 <br /> HOME INFORMATION (* required) <br /> Home ID number(if known): DMV X-plate number(if known): <br /> NEW m 35t (to / <br /> n Moving in from another state <br /> Has no home ID or X-plate because: (1 Coming out of county deed records <br /> Other: <br /> Manufacturer:PALM HARBOR Model:310HD30763A Year:2020 <br /> Manufacturer serial number HUD number <br /> PHH3100R19-13598A ORE548859 <br /> PHH3100R19-13598B ORE548860 <br /> *Number of sections:2 *Square footage:2280 *Number of bedrooms:3 *Number of bathrooms:2.5 <br /> *Type of roofing:ARCH. *Type of siding:VERT.CEMENT *Heating:ELECTRIC *Cooling:NONE <br /> *Date of sale:09/27/2019 *Sales price:167,804.00 *Includes land: ❑ Yes ❑■ 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 /> El 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 si re: Date: <br /> NEILA WHITE !N01/14/2020 <br /> ,414) <br /> TRANSPORTER INFORMATION'(if no 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 />