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Docusign Envelope ID:C79DC333-31F8-463A-9410-07E5C50A5A37 <br /> 5130 bros ) 1rl Lp <br /> o <br /> =SECTION 9;:;:::°: ;;=;;_i. ;:.;:::;::.i.-:::,: :-;.:<::::i:NATURE OF FIL NGlcheck all:th t'a. <br /> . .. a <br /> • New home to MHODS d' o r owner fio4(Dete:_) <br /> taVesSeriellasS1C g on d't Iorage <br /> EgAcueitylateleskhange m status J Trip Permit <br /> U datsite cilt itance peas te): <br /> :.:.:.:.....:.... ..................... <br /> . . .........:.. ... <br /> .r:S GT{ON�2�:;=::�-::.::..,, ..:�,... . , .: ARPL CANTaI[�FORM�ATtOW'�•le�se-lint:� . . . <br /> • Dealer/Seller 0 Lender J EscrowtTitleAgent ❑Owner/Buyer ❑Legal Representative <br /> Name: <br /> (first,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 /> �:.:��;�::,,1;�b11AEIN�ORMAT{OIIV=(lnfdrni�#ioi;inbold:is:re��iiired <br /> Home ID#: OR No Home ID: XNew Home ❑Out of state home ❑Leaving CountyDeed Records <br /> Manufacturer: Fleetwood (p I <br /> Model: Winnepeg 24443U Year: 2025 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> FLE210OR24-24272A <br /> FLE210OR24-24272B <br /> #of Sections: 2 Sq.footage: 1026 Bedrooms: 3 Bathrooms: 2 <br /> Roofing type: Arch Comp. Siding type: Lap Siding Heating type: Electric Cooling type: (one <br /> Date of sale: <br /> (lappltcable) 08/07/2024 Sale price: 94,118.00 Includes land: ❑Yes XNo <br /> Name: Alta Cima Corp. ba: FactoryExpo Homes License#: MSD 448 <br /> (first,middle,last) p• p <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: Q"(ha24e Date: 09/18/2024 <br /> .:.SECTI�N�:.;;:::�::` ::�::�;::::,�::�::..,::.:�.::�..;:.':::.::::::= ;:HOME<LOCATION-::.-.:::•.�::::::::::::.::�:;>:�:; "'��:::;::��°:-.:•..:�. •:-::::�:::. . . <br /> Current Address:2555 Progress Way <br /> City: Woodburn county: Marion State: OR Zip: 97071 <br /> Park Name:(if applicable) X[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: 5130 Briar Knob Loop <br /> City:Scotts Mills County:Marion State: OR Zip: 97375 <br /> Park Name:(f applicable) 0 This is a dealer lot or storage facility <br /> Transporter Name: Customer providing own freight •Phone: <br /> Address: City: State: <br /> Email: <br /> Page 2 <br />