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• <br /> lOG1 ) R R . <br /> DocuSign Envelope ID:08FFA475-9COF-46 DB-BEC0-7A0FE636AA9A S <br /> SECTION 1 NATURE OF FILING(check all that apply) <br /> II New home to MHODS 0 Adding or removing a co-owner ❑ Demolition(Date: ) <br /> ❑ Used home sale 0 Recording as real property ❑ Converted to storage <br /> ❑ Security interest change 0 Removing from real property status 0 Trip Permit <br /> ❑ Transfer by inheritance 0 Other(please note): <br /> SECTION 2 APPLICANT INFORMATION(please print) <br /> El Dealer/Seller 0 Lender ❑Escrow/Title Agent ❑Owner/Buyer 0 Legal Representative <br /> Name:Cas cad e Factory Homes, Inc Phone:503-981-5314 <br /> (first,middle,last) <br /> Address:590 N Pacific Hwy <br /> City:Woodburn State:OR ZIP:97071 <br /> Email:cascadehomes@yahoo.com <br /> HOME INFORMATION(information in bold is required) <br /> SEGTION"3-� --' . <br /> Home ID#: kit W OR No Home ID: El New Home 0 Out of state home 0 Leaving County Deed Records <br /> Manufacturer:Fleetwood Homes CO 0-7 34 3 <br /> Model:EG28443S Year:2024 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> FLE2100R23-23628A ORE 562762 <br /> FLE210OR23-23628E ORE 562763 <br /> #of Sections: 2 Sq.footage: 1,173 Bedrooms: 3 Bathrooms: 2 <br /> Roofing type: Arch Shingles Siding type: Cement Heating type: Elect Cooling type: N/A <br /> Date of sale: 11/20/2023 Sale price: $119,695 Includes land: ❑Yes 0 No <br /> (fapplicable) <br /> SECTION 4 DEALER INFORMATION(leave blank if no dealer) <br /> Name:Cascade Factory Homes, Inc License#:M SD-41 <br /> (first,middle,last) <br /> Address:590 N Pacific Hwy <br /> City:Woodburn State:OR zIP:97071 <br /> Email:cascadehomes@yahoo.com Phone:503-981-5314 <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 manufa tured structure or my interest in it.The information listed is true to the best of my knowledge and <br /> belief,and I understand it ca be used as evidence in court and is subject to a penalty of perjury. <br /> Signature: , Date:11/17/2023 <br /> SECTION 5 HOME.LOCATION, <br /> Current Address:590 N Pacific Hwy <br /> city:Woodburn county:Marion State:OR Zip:97071 <br /> Park Name:(if applicable) ■ This is a dealer lot or storage facility <br /> ❑This home is being <br /> moved to a new location Complete the section below <br /> New Address:130 Gates Hill Road <br /> city:Gates county:Marion State:OR zip:97346 <br /> Park Name:(if applicable) ['This is a dealer lot or storage facility <br /> Transporter Name:Superior Home Transport LLC Phone: 541-327-7805 <br /> Address:PO Box 1067 City: Jefferson State: OR <br /> Email:ritahartzell@gmail.com <br /> Page 2 <br />