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NE5 r <br /> , a. err\ <br /> SECTIOfU°:1 NATUREOFFILING(check all that apply) <br /> '/Le01.5 tiferN4i1-4CGS r vnpg-Tiewer ate: ) <br /> jerao-tfaxysak c c • r rty [lJ��?�r�48 c�Ge'�Ser gel <br /> KLAwitSligerefirthalte R c o ittgfr9rnoji1Dstpefty-stAlus [ Trip Permit <br /> aglaiferejrthcritansz_ ' /X)1.1 l-\(plevsepote): <br /> SECTION 2 ;:;;: APPLICANT INFORMATION (please print). :.. . : <br /> ®❑Dealer/Seller ❑Lender 0 Escrow/Title Agent ❑Owner/Buyer ❑Legal Representative <br /> Name:Alta Cima Corp. ba: FactoryExpo Homes Phone:503�•980.3990 <br /> airst,middle, last) P P <br /> Address:2555 Progress Way <br /> City:Woodburn State:OR ZIP:97071 <br /> Email:moconnell@factoryexpohomes.com <br /> HOME:I .FORMATION: information'.in bold is required).°: - <br /> Home ID#: IU E\ " OR No Home ID: 0 New Home 0 Out of state home ❑Leaving County Deed Records <br /> Manufacturer:Fleetwood 6o (D 5 1 c <br /> Model:Quartzville 28583F Year:2023 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> FLE2100R22-22784A ORE 560530 <br /> FLE2100R22-22784B ORE 560531 <br /> #of Sections: 2 Sq.footage: 1546 Bedrooms: 3 Bathrooms: 2 <br /> Roofing type: Arch. Comp. Siding type: Lap Heating type: Electric Cooling type: None <br /> Date of sale: 08/05/2022 Sale price: 178,055.05 Includes land: ❑Yes ❑® No <br /> (7f applicable) <br /> SECTION`�F°:: DEALERINF:ORMATION(leave blank if no dealer) <br /> Name: <br /> Alta Cima Corp. BA: FactoryExpo Homes License#:MSD 448 <br /> first,middle,last) P' P <br /> Address:2555 Progress Way <br /> City:Woodburn State:OR ZIP:97071 • <br /> Email:moconnell@factoryexpohomes.com Phone:503-980-3990 <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 understand it can be used as evidence in court and is subject to a penalty of perjury. <br /> Signature: 0/egit & Date: 01/23/2023 <br /> :SECTIONS HOME LOCATION.;.:. ... : .. <br /> Current Address:2555 Progress Way <br /> City:Woodburn County:Marion State:OR Zip:97071 <br /> Park Name: (f applicable) ❑This is a dealer lot or storage facility <br /> 0 This home is being moved to a new location Complete the section below <br /> New Address:1904 5th St. NE <br /> City:Salem County:Marion State:OR Zip:97301 <br /> Park Name: (if applicable) ❑This is a dealer lot or storage facility <br /> Transporter Name: Blue Haul Phone: 818-434-5501 <br /> Address:38681 Garden Dr. City: Scio State: OR <br /> Email:blue.haul@yahoo.com <br /> Page 2 <br />