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Dri PO <br /> DocuSign Envelope ID:F42FCC71-0089-4851-A01E--3B696F65CAkeGvuc <br /> D11 <br /> l a g g q ise,-(ik I� kL5 <br /> igt New home to MHODS ❑ Adding or removing a co-owner ❑ Demolition(Date:__ ' <br /> ❑ 'Used home sale ❑ Recording as real property ❑ Converted to storage <br /> ❑ .Security interest change ❑ Removing from real property status rgt Trip Petmit <br /> ❑ Transfer by inheritance ❑ Other(please note): <br /> . ................... .... <br /> :.:: <br /> .:SECTIO ° . :::.. . .........:r: <br /> -°q:Ifi� T iNFORMATION= I ase`•ilrit • <br /> IS(De,aler/Seller ❑Lender ❑Escrow/TitleAgent ❑Owner/Buyer ❑Legal Representative , <br /> Name: <br /> (lira,middle,last)•. Alta Cima Corp. Dba: Factory Expo Homes Phone:503-980-3990 <br /> Address: 2555 Progress Way <br /> City: Woodburn State:OR. ZIP: 97071 <br /> Email:moconnell@factoryexpohomes.com <br /> :•SECT(J >� ....r.�::::::::.:::.:...:.......:.. . _ <br /> :::::., ..::, .:,....:...:....... 1N.( . r,...�tlort;►h�biildsisregiifred)i'`. :�: • �;;::_�;':' `:•: ;::.:%:::.. <br /> Home ID#: NE W OR No Home ID: )gt New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer: Fleetwood (oO 8(9 50 • <br /> Model: Hartline 28603E Year:2024 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> FLE2100R23-23699A ORE 562920 <br /> FLE210OR23-23699E ORE 562921 <br /> #of Sections; 2 Sq.footage: 1600 Bedrooms: 3 Bathrooms:. 2 <br /> Roofing type: Arch Comp. Siding type: Vert. Cement Heating type: Electric Cooling type: None <br /> Date of sale: <br /> al'appriwble) 09/14/2023 Sale price: 142,296.59 Includes and: ❑Yes XNo <br /> . <br /> • Name: Alta Cima Corp. ba: FactoryExpo Homes License#:(/irst,middle,lase) p p MSD 448 <br /> . Address: 2555 Progress Way <br /> city:Woodburn state: OR. ZIP: 97071 <br /> Email: moconnell@factoryexpohomes.com Phone: 503=98Q-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: 7 / ir' e Date: 01/24/2024 <br /> :<::.::::::•:::...,.>::::::�::::>�-HONi �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 /> This home is being moved to a new location Complete the section below <br /> New Address: 12999 Bethlehem Dr. NE <br /> City: Gervais County: Marion State: OR Zip: 97026 <br /> Park Name:(if applicable) ❑This is a dealer lot or storage facility <br /> Transporter Name: Blue Haul Phone: 818-434-5501 <br /> Address: 38681 Garden Dr. City: Scio State: OR <br /> Email: blue.haul@yahoo.com <br /> Page 2 <br />