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• <br /> (,), ...._, .., A <br /> . 1 <br /> Q10 <br /> ?) ,,,,,\ jev s...v. , N „ tloii-- <br /> ;SEC..TION<7 •: :':::.:;::;';:::`:::.:::•.:: •:-:•:...NATURE!OF.F.ILING•(iheckallthatapplY).' .• ..: •::.•..... .: <br /> El New home to MHODS C]...A�dai��t:rent ving`a colQvvner, Eg-'I�em'olit n(l te:'-'s„ ) <br /> O Jsrd' n' e sal . cpordhips're Lp orrp�Crty ©'Corlverte3`to sto gel <br /> tySep4rIly,Iiiter6itschrthge la,ReAtavirtifrnrn•teal-property status ® Trip Permit <br /> nsstecl!y-hfheritance Cci,O to pleasetrple): <br /> SECTION2. ::i':::>::;: ;: .:::'.•:::•.•: ::;APPLICANT:'.INFORMATION:(please print):.•:•. •:;:••.. .. <br /> 0 Dealer/Seller 0 Lender 0 Escrow/Title Agent 0 Owner/Buyer ❑Legal Representative <br /> Name:Alta Cima Corp. ba: FactoryEx <br /> po p� EX o Homes Phase:503-9803990 .• <br /> Address:2555 Progress Way <br /> City:Woodburn state:OR ZIP.97071. <br /> Email:moconneil@factoryexpohomes.com <br /> SECTION13 ::•.•; .;:;:,...,.;••.HO111IE INFORMATION(Infor'rn tion:in`boldl3required).;;: ;;: . <br /> Home ID#: OR No Home ID: ©New Flame 0 Out of state home ❑Leaving County Deed Records <br /> Manufacturer:Fleetwood / •) <br /> Model:Chelan 24403E Year:2023 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> FLE210OR22-23098A <br /> FLE2100R22-23098E <br /> #of Sections: 2..._... Sq.footage: 93 Bedrooms: 2 Bathrooms :2`::. ...._ . , <br /> ,, .'Rootingtype: type:Arch'.Comp. Siding type: Vert. Cemt, HeatingElectric. : Cooling typet:�_Nene:.. - . <br /> e: <br /> Date of pik ale: 09/19/2022 Sala rice: 108 572.22 Includes land:(1/'apPrlcable).. p ❑Yes 0 No - ._.. .. - - __-. ._. ' <br /> -SECTION4,.,. :., •DEALERINFORMATION:(leave blank If no dealer) <br /> _ _ Name Alta Cima Corp.Psi,middle,last) D BA: Factory Expo Homes License#:MSD 448 <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: D/�yt � Date:01/27/2023 <br /> SECT101iV5'•; !: ._!: �`,..,;i.:6: ::.:::': ! :::::"•;::•:::•:;lHOME:LOCATI9N::,:•. ... • <br /> Current Address:2555 Progress Way <br /> City:Woodburn County:Marion State:OR Zip:97071 <br /> Park Name:((/'applicable) ❑This is a dealer lot or storage facility <br /> El This home Is being moved to a new location Complete the section below <br /> Now Address:240 Boulder St. C(1 3"I <br /> City:Detroit County:Marion State:OR Zip:97.244- <br /> Park Name:((f applicable) 0 This is a dealer lot or storage facility <br /> Transporter Name:Blue Haul Transportation Phone: 818-434-5501 <br /> Address:38681 Garden Dr. City: Selo State: OR <br /> Email:blue.haul@yahoo.com <br /> Page 2 <br />