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<br /> Dealer/sellerOwner/buyer
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<br /> ❑Lender ❑Escrow/title agent ❑Owner/bu er
<br /> y ID Legal representative
<br /> Name:Factory Expo Homes
<br /> Address(including city,state,and ZIP):2555 Progress Way,Woodbum,OR. 97071
<br /> Phone:503-981-0770
<br /> Email:moconnell@factoryexpohomes.com
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<br /> ( V DMV X plate number(if known):
<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: Honeydew 14441A Year: 2023
<br /> Manufacturer serial number. HUD number
<br /> FLE2100R23-23156A ORE 561091
<br /> *Number of sections: 1 *Square footage: 601 *Number of bedrooms: 1 *Number of bathrooms: 1
<br /> *Type ofroofing:ArCh Comp. *Type of siding: Vert. Cement 'Heating: Electric *Cooling: None
<br /> *Date of sale: 07/12/2022 *Sales price:57,949.00
<br /> ,ram`z v *Includes land: Yes �No
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<br /> Dealer name: Dealer license number: rvDealer address and phone:
<br /> Alta Cima Corp. MSD 448 2555 Progress Way
<br /> Dba: Factory Expo Homes Woodburn, OR. 97071
<br /> •
<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 /> 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.
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<br /> Blue Haul Transport 38681 Garden Dr.
<br /> Scio, OR. 97374
<br /> 818-434-5501
<br /> 440-2952(7/19/COM) Page 2
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