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<br /> ❑Change security interest 111 Change ownership
<br /> g Demolition Date of demolition:
<br /> ❑Recording as real property ❑Removing from real property status J2 Trip permit ❑Converted to storage
<br /> ❑Other:
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<br /> 0 Dealer/seller ❑Lender ❑Escrow/title agent ❑ Owner/buyer ❑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.corn
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<br /> Home ID number(rf I ri ): i DMV X-plate number(if known):
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<br /> ❑Moving in from another state
<br /> Has no home ID or X-plate because: n 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 ofroofiing:Ar'ch Comp. *Type of siding: Vert. Cement *Eleating: Electric *Cooling: None
<br /> *Date of sale: 07/12/2022 Sales p* rice:57,949.00 *Includes ❑
<br /> land: Yes XNo
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<br /> Dealer Iicense number: Dealer address and phone:
<br /> Alta Cima Corp. MSD 448 2555 Progress Way
<br /> Dba: Factory Expo Homes Woodburn, OR. 97071
<br /> •
<br /> I1This 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. 40��i��ra& 03/13/2023
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<br /> Transporter name: Transporter address and phone:
<br /> Blue Haul Transport 38681 Garden Dr.
<br /> Scio, OR. 97374
<br /> 818-434-5501
<br /> •
<br /> 440-2952(7/19/COM) Page 2
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