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ward Dr. Qb, q 305 <br /> Docusign Envelope ID:BBA8973C-AD5B-4531-AF00-8AF199666FCB <br /> SECTION 1 c NATURE OF FILIIVG,(check all that apply) • <br /> 0 New home to MHODS • or o ' <br /> p PA_Undeile cor n r p arty [ eAl,erte e-ster'age <br /> In/NcAtiyeintert*LaTailge e tus ❑■ Trip Permit <br /> n_2121zsiesizy,ilih r lce �1Aa e t e): <br /> SECTION 2 APPLICANT INFORMATION (pleaseprint) " <br /> D Dealer/Seller ❑Lender D 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 ZfP:97071 <br /> Email:agarcia@factoryexpohomes.com <br /> SECTION 3 HOME INFORMATION linformation in bold is required) <br /> Home ID#: NEW OR No Home ID: New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:CAVCO t.01 if <br /> Model:Ramblewood 24382R Year:2026 <br /> Serial Number(s) HUD Label Number(s) *Required if new home <br /> CAV2100R25-25106A ORE 569205 <br /> CAV2100R25-25106B ORE 569206 <br /> #of Sections: 2. Sq.footage: 886 Bedrooms: 2 Bathrooms: 1 <br /> Roofing type: ARCH COMP Siding type: LAP SIDING Heating type: ELECTRIC •'Cooling type:- NONE <br /> Date of sale: 5/1 2/2025 <br /> (tf applicable) . Sale price: $107,072.85 Includes land: ❑Yes No <br /> SECTION 4 -� DEALER INFORMATION (leave blankcif no.dealer) <br /> Name:Alta Cima CorpBA: FactoryExpo Homes License#:MSD448 <br /> (first, middle,last) pp <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: 4 4,gra„.ce„;,2, Date:9/29/2025 <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) I]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:498-9 WARD. DR, NE 5/13 4 b8j7 Ware) <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 />