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)41 of Lp E . SCC Mic U5 <br /> DocuSign Envelope ID:A98832F6-AE52-47AF-854 ,E4EB65F6AA € , <br /> � ti P4 •11,• <br /> 1,. r.r� r <br /> 51f,, li - ,1. . w , _ �1iJ � <br /> 3 <br /> laitttgafeNeoQ..eterat 0 Change ownership 1! i ..o • •, ,t, • .e• • • •• • <br /> e ti' g ea ► e ualoar n al opefOy aupper ' \ • •rt:• t• • ale <br /> r s uta c, -.M .,�.w aJ,. r"'y f� •'`@tiec'x v a.rr sy' 'v 2 �,r f 0.4-7 -- <br /> 0, !Y-••. +i iY •"�1'� h F �5 � �Ii7 B"_�i,r'1'f- ..Lk rA S^.�r'g �i ?.'( 'k � <br /> ` <br /> ❑Dealer/seller ❑Lender ❑Escrow/title agent I j Owner/buyer ❑ Legal representative <br /> Name:Rex Beard and Joyce Hernandez-Beard <br /> Address(including city,state,and ZIP):6970 SW King Blvd.Apt. 13 Beaverton OR 97008 <br /> Phone:503-521-6774 <br /> Email: p P 4 <br /> t ry` res -rergy . ri�v.,r SAYv B_ � "a n ? 2 ' e <br /> 2'� .j s r a a s z, a 9y .` e ° x4s""" .. til <br /> Home ID number(if known): DMV X-plate number(if known): <br /> TBD N E V✓ nrY 3 t)( <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 I Model:Athena Year:2020 <br /> IManufacturer serial number HUD number <br /> 245-000-H-A100202A ORE 549419 <br /> 245-000-H-A100202B ORE 459420 <br /> *Number of sections:2 *Square footage: 1296 I *Number of bedrooms:2 I *Number of bathrooms:2 <br /> *Type of roofing:ACCH COMP I *Type of siding:ACCH CEMENT I *Heating: ELECTRIC I *Cooling: NONE <br /> *Date of sale:7/9/2019 *Sales price:80181.00 j *Includes land: ❑Yes I]No yy <br /> L •ip E• ti. B A :: ,{„ p x d¢ o YC w+d'd✓}tyF� , "ko`"4F€`Ja. <br /> e'444 1 v it- r ,w,� .his n • „ � �� <br /> , avT"», l.Sti 3 •''S+'w .wX' 1 r..«.aNr i• ."Yw t...0 "atR.:.b <br /> Dealer name: Dealer license number: Dealer address and phone: <br /> Alta Cima DBA PO Box 129 <br /> Factory Expo Homes MSS 382 McMinnville OR 97128 <br /> 971-267-5024 <br /> 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. <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): Dealer signature: DocuSigned by: Date: <br /> Factory Expo Homes <br /> 00.44,7s41. a.,t, 11/12/2019 I 1:01 PM 1 <br /> mIt • <br /> rm � a .�4IJ nil <br /> V PiA. Jqp iJ , '� � �/Y Vd Qy t: � f�t�,•P� 4'•. ,..,v. <br /> IPIWB <br /> . Transporter name: Transporter address and phone: <br /> Superior Home Transport PO Box 1067 <br /> Jefferson OR 97352 <br /> 541-327-7805 <br /> 440-2952(7/17/COM) Page 2 <br />