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• Aq 4D5nns <br /> V'. 1 ` V B .6 r (56: <br /> DocuSign Envelope ID:F0A9D597-D0A6-4A14-8082-5EEA46CC1CADS de--1?) <br /> ' <br /> <t'rtF it mM yr,"fa r - c..,3.Fy ,� r s rk % - y f�� i�K�„ " a3to 2"aa4 # � .�kS 04� 114, 4+ 447n "n%4{5t <br /> ! ang •t y�nt <br /> .�,�,�., .,,�^:�.,.eLe st Q Change ownership altalEtlition Date of-€184;Reiition: <br /> ❑ e i g-as-realpreperty Claerneving from o epe tatus ®Trip permit [l-Gofweieddes-storage <br /> ❑ittiter: <br /> 1. 50tt ak }�5 4 � C ?��h� �..?y . ��ri a s� i •� � '4� r °`.✓, " ` c <br /> cZ <br /> El Dealer/seller ❑Lender ❑Escrow/title agent Owner/buyer <br /> e-✓ <br /> Name:CORA HYATT/SUSAN CONOVER -Tr : () (fi1' fY1i4, <br /> Address(including city,state,and ZIP):5345 NORMA AVE SE SALEM OR 97306 j <br /> Phone:503-508-8989 ; 11 <br /> C <br /> Email: <br /> d0 <br /> gat v a y I- Sr yfF�, ,,rherr'fit ,,a'.s� r s' �i� <br /> -- a � �a v,9-' ii. r k,1 l m'�' + ='''Q re C tl s -aft..° �n.- ....'�``5'%W€' eel <br /> `tr?a[da: ��,.�' ' �ti t . ... '''- " <br /> Home ID number(if known) DMV X-plate number(ff known): rn 3 5 (g 05 4 <br /> EW WJE <br /> ❑Moving in from another state <br /> Has no home ID or X-plate because: ❑Coming out of county deed records <br /> • ❑Other: <br /> Manufacturer:SKYLINE Model:MICRO Year:2019 <br /> Manufacturer serial number BUD number <br /> KW91-0226-L ORE 543012 <br /> • <br /> *Number of sections:1 *Square footage:437 *Number of bedrooms:1 *Number of bathrooms:1 <br /> *Type of roofing:ACCH COMP *Type of siding:ACCH CEMENT *Heating:ELECTRIC *Cooling:NONE <br /> *Date of sale:5-30-2018 *Sales price:21,900.00 *Includes land:D Yes 0 No <br /> y r r a M P .sem navy g$ S x kids <br /> alrfter <br /> 11 <br /> `e;., 5 µ"�ea` z 9er., L .c . �a,,, ai �' ? Ow a .a.ap, ..r..., w <br /> Dealer name: <br /> Dealer license number: Dealer address and phone: <br /> ALTA CIMA DBA MSS382 PO BOX 1295 <br /> FACTORY EXPO HOMES MCMINNVILLE OR,97128 <br /> 971-267-5020 <br /> 1 of all mortgages,deeds of trust,security interests,and liens.I have the <br /> ['This manufactured <br /> structure is free and clear <br /> legal right to sell this manufactured structure. <br /> I hereby declare that the above statement is true to the best of my knowledge and belief,and that I understand it is <br /> ' made for use as evidence in court and is subject to penalty for perjury. <br /> Dealer name(print): Dl eosignature: Date: <br /> �a j. Q� ,,K„� 4/4/2018 I 4:04 P MST <br /> FACTORY EXPO HOMES o�� �^'"�' Guc <br /> ,�.� 1 Tfi""-0" , -.sr� bbl 1:k.+' fi 'i ��Y. ; • e.3 J-�'' _✓ l{ +1.��-F yV' 4�k�i <br /> Fgs'W <br /> ,rte"�. �'t <N `h� } � �' pa� �.s`�tC-�_ . �M1^.Jz:.;v � � �� -Q'r'•k'''��r' -,t«� � <br /> Transporter name: Transporter address and phone: <br /> SUPERIOR HOME TRANSPORT 257 N 6TH ST <br /> JEFFERSON OR 97352 <br /> 503-551-3454 <br /> 440-2952(7/17/COM) Page 2 <br />