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Docusign Envelope ID:7CE7 7-5023 8I7 5 B-172A290BSB n 4 61• w A r� <br /> P t t V vet <br /> SECTION—I NATURE OF FILING (check all thatapply) ` ' <br /> 111 New home to MHODS ��. di r rarirg.a,,,ce;ovvyer em ' i te: ) <br /> U PSgivaale 2A g e ert l tastorage <br /> VVailyi 'WNW ge scKltgalOilaglisertrIverhropv.ftyxtaus 0 Trip Permit <br /> �� nhSRl-ke th le i <br /> SECTION 2 °- APPLICANT INFORMATION (please print) <br /> 0 Dealer/Seller ❑Lender ❑Escrow/Title Agent ❑Owner/Buyer ❑Legal Representative . .-. <br /> Name'Alta Cima CorpFactory DBA: Expo Homes Phone:503-980-3990 <br /> (first,middle,last) <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#: I J E w OR No Home ID: ❑New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:CAVCO to 12,I-4 1- <br /> Model:Harrisburg 28483U Year:2026 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> CAV210OR25-24791A <br /> CAV2100R25-24791B <br /> #of Sections: 2 -. • Sq.footage: 1279 Bedrooms: 3 Bathrooms: 2 <br /> Roofing type: Arch Co►7ip Siding type: LAP Heating type: Electric Cooling type: :None: <br /> Df pp`f ab 04/1 Q/2025 Sale price: $96,554.00 Includes land: ❑Yes 0 No <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: 4i i Date:05/15/2025 <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:20815 Walnut St <br /> City:Aurora County:Marion State:OR Zip:97002 <br /> Park Name: (if applicable) ❑This is a dealer lot or storage facility <br /> Transporter Name: Doug Walton Phone: 541-730-6191 <br /> Address: City: Aurora State: OR <br /> Email: Charligirl95@gmail.com <br /> Page 2 <br />