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<br /> jJ Dealer/seller E 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,corn
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<br /> Home ID number(if known): DMV X-platc number(if known): 0
<br /> • ❑ Moving in from another state (59 gS t0O)•
<br /> Has no home ID orX-plate because: ❑Coming out of county deed records
<br /> ❑Other:
<br /> Manufacturer:Fleetwood • Model: Chelan 24403V Year: 2022.
<br /> • Manufacturer serial number.':' • HUD number '
<br /> • FLE2100R22-22509A
<br /> •
<br /> FLE2100R22-22509B
<br /> •
<br /> •
<br /> *Number of sections: 2 *Square footage: 933 *Number of bedrooms: 3 *Number of bathrooms: 2
<br /> *Type of roofing: Metal . *Type ofsiding:Vert. Cement *Heating: Electric *Cooling: None
<br /> •
<br /> *Date of sale: 03/15/2021 *Sales price: 76,964.49 *Includes land: ❑ Yes XNo
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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 /> ®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 /> • Thereby 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. /�Ir-ii.4 05/25/2022
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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) • Page 2
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