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DocuSign Envelope ID:65E51 FEO-B5F0-4936-9834-B32EE55D8219
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<br /> 0 Dealer/seller ❑Lender ❑Escrow/title agent ❑ Owner/buyer ❑Legal representative
<br /> Name:Factory Expo Homes
<br /> Address(including city,state, and ZIP):2555 Progress Way,Woodburn, OR. 97071
<br /> Phone:503-981-0770
<br /> Email:moconnell@factoryexpohomes.com
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<br /> Home ID number(if.known): DMV X-plate number(if known):
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<br /> Moving
<br /> 22Moving in from another state
<br /> Has no home ID or;X-plate because: ❑Coming out of county deed records
<br /> ❑Other:
<br /> Manufacturer:Fleetwood -I Model: Oakridge 24482V - I Year: 2021
<br /> Manufacturer serial number. HUD number
<br /> FLE2100R20-20770A
<br /> FLE210OR20-20770B
<br /> *Number of sections; 2 I *Square footage: 1170 I *Number of bedrooms: 3 *Number of bathrooms: 2
<br /> *Type of roofing: Arch. Con'ip*.Type of siding:Vert. Cement I *Heating: Electric *Cooling: None
<br /> *Date of sale: 02/14/2020 *Sales price: 76,540.00 *Includes land: ❑ Yes No
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<br /> Dealer name: Dealer license number: Dealer address and phone:
<br /> Alta Cima Corp. MSD 448 2555 Progress Way -
<br /> Dba: Factory Expo Homes Woodburn,OR, 97071
<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: Date:
<br /> Alta Cima Corp. %�'2a� ,Q��tii
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<br /> Transporter name: Transporter address and phone:
<br /> Superior Home Transport, LLC PO Box 1067
<br /> Jefferson, OR. 97352
<br /> 440-2952(7/19/COM) Page 2
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