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Docusign Envelope ID:EBF00070-DB7C-4B60-826C-2AFDDE6D13C1 1 r ' ie <br /> -'"SECTION 15 ' `a'". q ' , NATURE OF FILING-(check all that.:apply) <br /> ®❑ New home to MHODS ISZVd3W et ii a ca caner e: <br /> 10,,A5(84(oNanolt Vkieninl p erty llid4agage <br /> �e ai.tfi e tatus l Trip Permit <br /> r • y4�• ltra tcte): <br /> SECTION 2 `r' ,,.. , <br /> APPLICANT INFORMATION (please print) v �:; <br /> El Dealer/Seller ❑Lender ❑Escrow/Title Agent ❑Owner/Buyer ❑Legal Representative <br /> Name:Alta Cima CorpBA: FactoryExpo Homes Phone:503-980-3990' <br /> (first,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.;INF,ORMATION;(information in,bol,d.is required) <br /> Home ID#: OR No Home ID: ®❑New Home 0 Out of state home ❑Leaving County Deed Records <br /> Manufacturer:Fleetwood 436 <br /> Model:Chelan 24403E Year:2025 <br /> Serial Number(s) HUD Label Number(s) *Required if new home <br /> FLE2100R25-24781 A <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 0 No <br /> (If applicable) <br /> SECTION 4 "? t DEALERkINFORMATION.(leaveEblankifno dealer) <br /> Name:Alta Cima Corp DBA: Factory Expo Homes License#:MSD448 <br /> (first,middle,last) <br /> Address:2555 Progress Way • <br /> city:Woodburn State:OR ZIP:97071 <br /> Email:agarcia@factoryexpohomes.com Phone:503-980-399Q <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: 47 a0a_a, 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: (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: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 />