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:.. S 134 77 S•4-9 4-o n : Ste, c e.�. �. <br /> Docusign Envelope.ID:;AC58947C-12FE-4A1 B-8B49-012F49F6D6F0 <br /> SECTION 1 NATURE-OF FILING (check all tha(apply).. <br /> ■ New home to MHODS NIAidapfurt9tig,r6111.9wner o ate: <br /> \x taliNT rie c n s • rty N--e&rotfferlo storage ,. , <br /> e t e o • status ■❑ Trip Permit. <br /> SVirekAvivi144.e.r.itagee <br /> SECTION 2 APPLICANT INFORMATION (please•print) •, <br /> Dealer/Seller ❑Lender ❑Escrow/Title Agent E Owner/Buyer ❑Legal Representative - - <br /> .Name:: <br /> Ursr,>nrddle, lasa) lta Cima:Corp DBA:..Factory Expo Homes Phone 503 98:.0:3990 <br /> Address:2555:Progress Way . . <br /> 'City:Woodburn state:OR ZIP:97071 - - <br /> Email:agarcia@factoryexpohomes.com <br /> SECTION 3 , HOME INFORMATION,,°(information inAbold is required) ,a: , <br /> Honie ID#:NLVI.. OR No Home ID: ®❑New Home ❑Out of state home.❑Leaving County Deed Records <br /> Manufacturer:CAVCO ••. - <br /> • <br /> Mbdel:Harrisb'Grg 28483U <br /> Serial Number(s) HUD Label Number(s) *Required if need home <br /> CAV2100R25-25055A ORE 568930 <br /> CAV2100R25-250556 ORE 568931 <br /> #.rof Sections:,,,2.:.:;;-:• Sq.footage: 1279 Bedrooms: 2 Bathrooms: 2 <br /> 'Roofing type:. ARCH COMP Siding type: LAP SIDING Heating.type: ELECTRIC•<. ..Coolingtype:2:NOINE "I <br /> •:.Datepf5ale: <br /> ..(fapplicable) <br /> 6/1'9/2025. Sale price: $95,330.00 <br /> Incl}ides land: Yes �_No <br /> SECTION-4 ;' DEALER'INFORMATION:(leave blank if nodealer). „ <br /> • <br /> • -Nanier.: <br /> (frsi, middle, last)Alta Cima Corp DBA: Factory Expo Homes- License# MSD448 <br /> • <br /> Address:2555-Progress Way .._ <br /> city:Wdbdburn . State:OR z>.P:97071 . . <br /> •Eniaii: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: / G%LC/i Date:9/16/2025 <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) El 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:5847 Stayton Rd SE <br /> City:Turner County:Marion State:OR Zip:97392 <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 />