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<br /> Q Dealer/seller 0 Lender ❑Escrow/title agent ❑ Owner/buyer y 0 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 /> E \J (D CD 44 r'1
<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 I Model; Redding 28483T I Year: 2022
<br /> . Manufacturer serial number. I . HUD number
<br /> FLE2100R21-22120A
<br /> FLE2100R21-221028
<br /> *Number of sections: 2 1 *Square footage: 1279 *Number of bedrooms; 3 I *Number of bathrooms; 2
<br /> *Type of roofing: Arch. Comp.I *Type of siding: Vert, Cement 1 *Heating: Electric I *Cooling: None
<br /> *Date * 23 96 0
<br /> of sale; 11/12/2021 I Sales price: 1 7. 4 I Includes land:(] Yes gNo
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<br /> Dealer name; Dealer license number: Dealer address and phone:
<br /> Alta Clma Corp. MSD 448 2555 Progress Way
<br /> Dba; Factory Expo Homes Woodburn, OR. 97071
<br /> /This manufactured structure is free and clear of all mortgages,deeds of trust,security interests,and liens. I have the
<br /> legal rightht to sell this manufactured structure.
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<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. 0 l�hae 01/04/2022
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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) Pnge 2
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