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<br /> ■❑Dealer/seller ❑Lender ❑ Escrow/title agent ❑ Owner/buyer ❑Legal representative
<br /> Name:Factory Expo Homes
<br /> Address(including city,state, and ZIP):2555 Progress Way, Woodburn, OR. 97071
<br /> Phone:503-981-0770
<br /> Email:moconnell@factoryexpohomes.com
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<br /> Home ID number(if known): DMV X-plate number(if known):
<br /> NEW (oObi cf5
<br /> ❑Moving in from another state
<br /> Has no home ID or X-plate because: ❑Coming out of county deed records
<br /> ❑Other:
<br /> Manufacturer:Fleetwood Model: Redding 28483T Year: 2021
<br /> Manufacturer serial number. IFIUD number • • .
<br /> FLE2100R21-21725A
<br /> FLE2100R21-21725B
<br /> *Number of sections: 2 *Square footage: 1279 *Number of bedrooms: 3 *Number of bathrooms:2
<br /> *Type of roofing: Arch. Comp *Type of siding:Vert. Cement *Heating: Electric *Cooling: None
<br /> *Date of sale: 10/12/2020 *Sales price: 73,952.61 *Includes land: ❑ Yes r,SitNo
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<br /> Dealer name: Dealer license number: Dealer address and phone:
<br /> Alta Cima Corp. MSD 448 2555 Progress Way
<br /> Dba: Factory Expo Homes Woodburn, OR. 97071
<br /> OThis 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 /> Alta Cima Corp. - - leh= .e 06/14/2021
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<br /> Transporter name: Transporter address and phone:
<br /> Superior Home Transport, LLC PO Box 1067
<br /> Jefferson, OR. 97352
<br /> 440-2952(7/19/COM) Page 2
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