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-7 P.,-7 Ln 5Pk trArne,r. <br /> SECTION 1.. NATURE OF FILING(check all that apply) • <br /> jJ New home to MHODS SlAijjear...rdilottikeraaOfvner e: ) <br /> Wtiftzleatteie <br /> liK,Acapels.aslaar3r.egrty hhe Lte'5tQrage <br /> Uvets4e it nt r tL4 e 3-42tzuelinsOludsillzoractOtatus 0 Trip Permit <br /> sf a ri•tt a th a to <br /> SECTION 2„ APPLICANT INFORMATION(please print) • <br /> ID Dealer/Seller ❑Lender ❑Escrow/Title Agent ❑Owner/Buyer ❑Legal Representative <br /> Name:HOMES DIRECT OF OREGON LLC <br /> (first,middle,last) Phone:541-928-2083 <br /> Address:3838 PALM HARBOR DR NE <br /> City:MILLERSBURG State:OR ZIP:97321 <br /> Email:TANYA.ABADILLA@HOMES.DIRECT <br /> SECTION 3 HOME INFORMATION (information in bold is required) <br /> Home ID#:New OR No Home ID: Q New I-Iomc ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:PALM HARBOR (O 1 3 41 <br /> Model: 310HD28603C Year:2025 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> PHH3100R24-16055A ORE 564175 <br /> PHH3100R24-16055B ORE 564176 <br /> #of Sections: 2 Sq.footage: 1800 Bedrooms: 3 Bathrooms: 2 <br /> Roofing type: ARCH Siding type: FIBER CEM Heating type: GAS Cooling type: 'NONE - <br /> Date <br /> t applicable) <br /> sale: 08/01/2024 Sale price: 184,075.00 Includes land: ❑Yes 0 No <br /> SECTION 4x' DEALER INFORMATION(leave blank if no dealer) <br /> Name:HOMES DIRECT OF OREGON LLC <br /> Ors!,middle,last) License#:MSD 523 <br /> Address:3838 PALM HARBOR DR NE <br /> City:MILLERSBURG State:OR ZIP:97321 <br /> Email:TANYA.ABADILLA@HOMES.DIRECT Phone:541-928-2083 <br /> I hereby declare 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 or my interest in it. The information listed is true to the best of my knowledge and <br /> belief,and I under it can be Ise s evide}ce ' court and is subject to a penalty of perjury. <br /> Signatu Date: <br /> SECTION 5 ;HOMELOCATI'ON E • <br /> Current Address:3838 PALM HARBOR DR NE <br /> City:MILLERSBURG County:LINN State:OR Zip:97321 <br /> Park Name: (if applicable) ['This is a dealer lot or storage facility <br /> ■❑This home is being moved to a new location Complete the section below <br /> New Address:49.24 DEHLIN LN SE 4 7 7 De k lj n LYI S/ <br /> City:TURNER County:MARION State:OR Zip:97392 <br /> Park Name: (if applicable) ❑This is a dealer lot or storage facility <br /> Transporter Name:BENNETT TRUCKING&TRANSPORT Phone: 541-879-3444 <br /> Address:409 BIGHAM BROWN RD City: EAGLE PT State: OR 97524 <br /> Email:YOR@BENNETTIG.COM <br /> it <br /> Page 2 <br />