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Q1D 1s - 34-1- 4„). <br /> :SECTION 7::';::::: :::: :: :... :: ::: NATURE'OF!JUNG.(iheck all that apply) : <br /> N❑ New home to MHODS N—fOi lutrinoi )1e oli te:' ) <br /> in tiALpr6REtys ge <br /> I d fla ge e ® Trip Permit <br /> EiNatfs eritance CANpleasevggle): <br /> :SECTIOIV`2::::'::::: ::::: ::::: AP:PLICANTIINFORMATION:(pleaseprint): . : :::: . .. . ... <br /> 0 Dealer/Seiler ❑Lender ❑EscrowffitleAgent ❑Owner/Buyer ❑Legal Representative <br /> /e.ias:Alta Cima ba: FactoryEx <br /> po middle,last) Corp.►P• Ex O Homes Phone:503-980-3990" • <br /> Address:2555 Progress Way <br /> City:Woodburn State:OR ZIP:97071 <br /> Email:moconnell@factoryexpohomes.com <br /> HOMEIINFORMATION.:(informationfin:baldi5:re uire <br /> Home ID#: OR No Home ID: El New Home El Out of state home ❑Leaving County Deed Records <br /> Manufacturer:Fleetwood 6,0( 4 3 <br /> Model:Chelan 24403E Year:2023 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> FLE210OR22-23098A <br /> FLE210OR22-23098B <br /> #of Sections: 2 Sq.footage: 93 Bedrooms: 2 Bathrooms: 2 <br /> Roofing type: Arch.Comp. Siding type: Vert. Cemt. Heating type: Electric Cooling type: None <br /> Date of sale: 09/19/2022 Sale 108,572.22 Includes land:gfapplicable) price: El Yes El No <br /> • <br /> SECTION 4. . : ... : _ :;:..:: DEALER INFORMATION leave blank If no dealer) <br /> Na"50Alta Cima Corp. Factory DBA: Expo Homes License#:MSD 448 <br /> first•middle,last) <br /> Address:2555 Progress Way <br /> City:Woodbum 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: CYCovutode Date:01/27/2023 <br /> SECTIONS;: :.:: ,.°::°:::;::::::. €HOME:LOCATION . <br /> Current Address:2555 Progress Way <br /> City:Woodburn County:Marion State:OR Zip:97071 <br /> Park Name:(if applicable) ❑This is a dealer lot or storage facility <br /> ❑I This home is being moved to a new location Complete the section below <br /> New Address:240 Boulder St. q 1 34 7-, <br /> City:Detroit County:Marion State:OR Zip:0;244- <br /> Park Name:(if applicable) ❑This is a dealer lot or storage facility <br /> Transporter Name:Blue Haul Transportation Phone: 818-434-5501 <br /> Address:38681 Garden Dr. City: Scio State: OR <br /> Email:blue.haul@yahoo.com <br /> Page 2 <br />