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q 6 l--a ke6DrSG L <br /> Docusign Envelope ID:OAD25FDE-2E2E-4CDA-B49E-63C15852132F " hl a 1305 <br /> SECTION 1 NATURE OF.FILING•(check all thatapply) ;; <br /> ❑ New home to MHODS �d �vner LDgtS�ii lili>n ate: ) <br /> er,. sa r_S../..,reNtaitIllszealtroperty •edt storage <br /> Sec m s ehaRge , e •o axear oyerty status ° ] Trip Permit <br /> ES.di nib ' rita ceO <br /> SECTION 2 APPLICANT INFORMATION (please print) <br /> 0 Dealer/Seller ❑Lender ❑Escrow/Title Agent ❑Owner/Buyer ❑Legal Representative <br /> Name:Alta Cima CorpDBA: Factory <br /> Expo <br /> Homes Phone:503-980-3990 <br /> (first, middle,last) <br /> Address:2555 Progress Way <br /> city:Woodburn State:OR z1P:97071 <br /> Email:agarcia@factoryexpohomes.com <br /> SECTION 3 - , HOME INFORMATION (information in bold is required) ,x . <br /> — <br /> Home ID#: NEW OR No Home ID: ❑■ New Home 0 Out of state home 0 Leaving County Deed Records <br /> Manufacturer: Fleetwood 8 Co 5 •-7 <br /> Model:Redding 28483E Year:2025 ... <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> FLE2100R24-24487A <br /> FLE2100R24-24487B <br /> #of Sections: 2 Sq.footage: 1280 Bedrooms: 2 Bathrooms: 2 <br /> Roofing type: ARCH COMP Siding type: VERT CEM Heating type: ELECTRIC Cooling type: NONE <br /> Date of sale:applicable) � •�6'-� 0Sale price: $114,422.61 Includes land: ❑Yes No <br /> (If � <br /> SECTION 4 DEALER INFORMATION (leave blank if no dealer) <br /> Name:Alta Cima CorpBA: FactoryExpo Homes License#:MSD448 <br /> (first, middle, last) p p <br /> Address:2555 Progress Way <br /> City:Woodburn State:OR .ZIP:97071 <br /> Email:agarcia@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: A ?aiLcza,' <br /> Date:12/18/2024 <br /> SECTION 5 ,` HOME LOCATION.. <br /> Current Address:2555 Progress Way <br /> City:Woodburn County:Marion State:OR zip:97071 <br /> Park Name: (f 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:7596 Lakeside Dr <br /> City:Salem County:Marion State:OR Zip:97305 <br /> Park Name: (if applicable) ❑This is a dealer lot or storage facility <br /> Transporter Name: Blue Haul Transportation Phone: 818-434-5501 <br /> Address:38681 Garden Dr City: Scio State: OR <br /> Email: blue.haul@yahoo.com <br /> Page 2 <br />