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i. • r <br /> 2:gt2g-i AlofkvIciplir Rol sE on s orz q.135-F <br /> X New home to MHODS LI Adding or removing a co-owner EI Demolition(Date: • ) <br /> o Used home sale Ej Recording as real property El Converted to storage <br /> 0 Security interest change El Removing from real property status tSt Trip Permit <br /> o Transfer by inheritance El Other(please note): <br /> SECTION2 APPLICANT INFORMATION 1plesepnnt) <br /> gDealer/Seller O Lender Ej Escrow/Title Agent Owner/Buyer fl Legal Representative <br /> Name: <br /> (f1rsi, last) Alta Cima Corp. Dba: Factory Expo Homes Phone:503-980-3990 <br /> Address: 2555 Progress Way <br /> City: Woodburn State:OR. 7IP: 97071 <br /> Email:moconnell@factoryexpohomes.com <br /> SECTION3 HOME INFORMATION(Information lh bold is requlid) <br /> Home lD#: NEW OR No Home ID: XNewHome El Out of state home El Leaving County Deed Records <br /> Manufacturer: Fleetwood 91-1 <br /> Model: Harrisburg 28483U Year: 2024 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> FLE2100R24-23838A ORE 563347 <br /> FLE2100R24-23838B ORE 563348 <br /> #ofSeetions: 2 Sq.footage: 1279 Bedrooms: 3 Bathrooms: 2 <br /> Roofing type: Arch Comp, Siding type: Vert. Cement Heating tYPe: Electric Coolingtype: None <br /> Date of sale: <br /> 01/09/2024 Sale price: 110,747.35 Includes land: El Yes RNo <br /> SE (Ifrodicable) <br /> PIO N14:1:!:fii!g;•:i §1:;i:::q i i I.giOloEALERRIFonivw poroe-aior;1310W#ino ddkr):- •. <br /> Name: <br /> (firstdniddle,las Factory t) Alta Cima Corp. Dba: Facto 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: 7/pirA /6904./A211 Date: 03/21/2024 <br /> SECTION 5 ......................................................................... • <br /> Current Address:2555 Progress Way <br /> County: Marion <br /> City: <br /> Woodburn State: OR Zip: 97071 <br /> Park Name:(if applicable) Nt This is a dealer lot or storage facility <br /> V(This home is being moved to a new location Complete the section below <br /> New Address: 28681 Northfork Rd. SE <br /> City: Lyons County-1-Li Marion state: OR Zip: 97358 <br /> Park Name:(if applicable) D This is a dealer lot or storage facility <br /> Transporter Name: Blue Haul Transport Phone: 818-434-5501 <br /> Address; 38681 Garden Dr. City: SCi0 State: OR <br /> Email: blue.haul@yahoo.com <br /> Page 2 <br />