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5 .. <br /> A-ri cik N)L-- <br /> Docusign Envelope ID:EBF00070-QB7C-�}B60 826C 2AFCDE6D13C1 �/ �LGm <br /> ;SECTION 1 NATURE OF FILING.(check eall that apply) `' <br /> New home to MHODS " c k ,0c:40 a caner i i ne: ) <br /> o 1B( c d p erty IS-lNef uartdddt o age <br /> e iglkgrfikingVsaarsailuellerOtatus ❑® Trip Permit <br /> reaNa'l axe): <br /> SECTION 2 APPLICANT INFORMATION-(please,priint) <br /> 0❑Dealer/Seller ❑Lender ❑Escrow/Title Agent ❑Owner/Buyer ❑Legal Representative <br /> Name:Alta Cima CorpBA: FactoryExpo Homes Phone:503-980-3990 <br /> Est,middle,last) P p <br /> Address:2555 Progress Way <br /> City:Woodburn State:OR ZIP:97071 <br /> Email:agarcia@factoryexpohomes.com <br /> SECTION 3 HOME INFORMATION (information.in bold is required) <br /> Home ID#: OR No Home ID: ■❑New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer: Fleetwood I -436 <br /> Model:Chelan 24403E Year:2025 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> FLE2100R25-24781A <br /> FLE2100R25-24781 B <br /> #of Sections: 2 Sq.footage: 765 Bedrooms: 3 Bathrooms: 2 <br /> Roofing type: ARCH COMP Siding type: LAP Heating type: ELECTRIC Cooling type: NONE <br /> Date of sale: 02/28/2025 Sale price: $106,155.23 Includes land: ❑Yes ❑No <br /> al-applicable) <br /> a <br /> SECTION 4 bEALERINFORMATION,(leave blank ifno°dealer) .':a; <br /> Name. <br /> 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 ,cQ7,e...a, .Cc� Date:04/18/2025 <br /> SECTION 5 HOME.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:4753 Patricia NE <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 />