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<br /> DocuSign Envelope ID:018B707E-E036-49C9-C'-DC6AA244DAF6
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<br /> - - • - crewititle_agent. 0 Owner/buyer Otte-gal-representative
<br /> •Name:Lee Piculell
<br /> Address(including city,state,and ZIP):702 Hampden Lane NE Salem OR 97317
<br /> Phone:206-949-9943
<br /> Email:
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<br /> Home ID number(if known): DMV X-plate number(if known):
<br /> TBD m 3 55858
<br /> 0 Moving in from another state
<br /> Has no home ID or X-plate because: 0 Coming out of county deed records
<br /> 0 Other:'
<br /> Manufacturer: SKYLINE [Model: 1 Year:
<br /> Manufacturer serial number, • HUD number
<br /> KW91-0405-K A ORE 539935
<br /> KW91-0405-K B ORE 539936
<br /> *Number of sections:2
<br /> *Square footage:822 *Number of bedrooms:2 *Number of bathrooms:1
<br /> *Type of roofing:ACCH COMP I *Type of siding:ACCH CEMENT *Heating: ELECTRIC *Cooling: NONE
<br /> *Date of sale:3/13/2020 *Sales price:57119.00 *Includes land:0 Yes E:1 No
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<br /> Dealer name: Dealer license number: Dealer address and phone:
<br /> Alta Cima DBA PO Box 1295
<br /> Factory Expo Homes MSS 382 McMinnville OR 97128
<br /> 971-267-5024
<br /> OThis 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 signatur-: DocuSIgned by: Date:
<br /> Factory Expo HomesCv&1'4cUtir.. 5/19/2020 1 9:15 AM r
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<br /> Transporter name: Transporter address and phone:
<br /> Dougs Mobile Home Service, INC 112692 Fry Road NE
<br /> Aurora OR 97002
<br /> 503-799-0539
<br /> 440-2952(7/17/COM) Page 2
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