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ON 'iv-tU <br /> DocuSign Envelope ID:F42FCC71-0089-4851-A01E--3B 6996F65CP,D1 <br /> \ a g q q & k ) nerr) , &cuCF.iS <br /> ....... .:......:.:.. .:...,.......:......,...:..::,.:,:..:.:.,..;...:..:...:.._..:NATIifR�:OFF.ILING•:(the�k'all:that�a' I )...:..:....::�: <br /> :.:,:.................,...:..,.......;.......•,...,,.,...::.,,..::..�:.:•. LSPY.�':�-.:: :•::>::�:` :� :,::;:::�,�.:: �.::. ,....: <br /> ► 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 'hip Permit <br /> ❑ 'Transfer by inheritance 0 Other(please note): <br /> :.•:::..:::.: .:::::::: 1pPLICANT INFOAMATIO :..: <br /> : ....::::..:.. :. ,.....:.... .... .......... :... ..... .,.... ph;asP print): <br /> Dealer/Seller ❑Lender ❑Escrow/ritleAgent ❑Owner/Buyer 0 Legal Representative <br /> Name: <br /> (first,middle Iasi).. • Alta Cima Corp. Dba: Factory Expo Homes Phone:503-980-3990 <br /> Address: 2555 Progress Way <br /> City: Woodburn State:OR. Z P: 97071 <br /> Email:moconnell@factoryexpohomes.com <br /> :...... ON 3; ;±`;>;i;; : ::;;,: ;;;;.::.s!',HOME INFORMAT .,,.,•.:::. :. old i:..eq .... <br /> s.....:::....... IOhtillnfofntatloriahbold;isregllired)- i :> •::::::::::::::.. •• <br /> Home ID#: NE OR No Home TD: XNew Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer: Fleetwood (06 8(9 5 <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 /> Date <br /> ollca le) 09/14/2023 Sale price: 142,296.59 Includes land: ❑Yes RNo <br /> '� „DEAIsER.,INF:BRMATION:.Qeave:blankif:na:deafei) : :.: ::';' ;`::;:::;:::::.;.:.�-::;.::•::.. <br /> Name: Alta Cima Corp. ba: FactoryExpo Homes License#: MSD 448 <br /> (first middle,last) p p <br /> . Address: 2555 Progress Way <br /> City: <br /> Woodburn State: pR, ZIP: 97071 <br /> Email: moconnell facto ex ohomes.com Phone: <br /> @ rY p <br /> 503=980-3990 <br /> I herebydeclare this manufactured structure <br /> fracture is free and clear of all mortgages,deeds of trust,security interests,and liens.I have the <br /> legal right to sell this ma <br /> nufactured struct <br /> ure or myinterest in it. The in <br /> formation 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: t /(. oJut4 Date: 01/24/2024 <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 />