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60„.- -,VeD ,-- 1, 1 vorcL SECTION 1 NATURE OF FILING(check all that apply) . _ ❑ New home to MHODS ❑ Adding or removing a co-owner ❑ Demolition(Date: ❑ Used home sale ❑ Recording as real property ❑ Converted to storage D Security interest change ❑ Removing from real property status ❑� Trip Permit ❑ Transfer by inheritance ❑ Other(please note): SECTION 2 APPLICANT INFORMATION (please print) , ❑� Dealer/Seller ❑Lender ❑Escrow/Title Agent ❑OwncrBuyer ❑Legal Representative • Name:HOMES DIRECT OF OREGON LLC middle,last) Phone:first, Address:3838 PALM HARBOR DR NE City:MILLERSBURG State:OR ZIP:97321 Email:TANYA.ABADILLA@HOMES.DIRECT • SECTION3 • HOME INFORMATION (information in bold is required) Home ID#: OR No Home ID: ❑■ New Home ❑Out of state home ['Leaving County Deed Records Manufacturer:PALM HARBOR I a ( b Model:310H D30703A Year:2017 Serial Number(s) HUD Label Number(s)*Required if new home PHH3100R16-11867A ORE 532273 PHH3100R16-11867E ORE 532274 #of Sections: 2 • Sq.footage: 1920 Bedrooms: 3 Bathrooms: 2 • Roofing type: ARCH Siding type: FIBER CEM Heating type: ELECTRIC Cooling type: NONE • Date of sale: 7/23/2024 Sale price: , afapplicableJ 186 017.00 Includes land: ❑Yes lEj No • SECTION 4`°" DEALER INFORMATION (leave blank if no dealer) Name:HOMES DIRECT OF OREGON LLC License#:MSD 523 Urst,middle,last) Address:3838 PALM HARBOR DR NE • • City:MILLERSBURG State:OR ZIP:97321, Email:TANYA.ABADILLA@HOMES.DIRECT Phone:541-928-2083 I hereby declare this manufactured structure is free and clear of all mortgages,deeds of trust,security interests,and liens.I have the legal right to sell this manufactured stru ture or my interest in it. The information listed is true to the best of my knowledge and belief,and I tinders i can be used a•. e idence i c • and is subject to a penalty of petjury. Signature. '1 / Date: SEGTION'5.;`. " •'`HOME;L`OCATION Current Address:3838 PALM HARBOR DR NE City:MILLERSBURG County:LINN State:OR Zip:97321 Park Name: (if applicable) This is a dealer lot or storage facility ■❑This home is being moved to a new location Complete the section below New Address:18726 BUTTEVILLE RD NE City:AURORA County:MARION State:OR Zip:97002 Park Name:(if applicable) - ❑This is a dealer lot or storage facility Transporter Name:BENNETT TRUCKING&TRANSPORT Phone: 541-879-3444 Address:409 BIGHAM BROWN RD City: EAGLE PT State: OR 97524 Email:YOR@BENNETTIG.COM • Page 2