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<br /> Q Dealer/seller ❑Lender ❑Escrow/title agent 0-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):
<br /> EVJ rn3CP02-` .11
<br /> n Moving in from another state
<br /> Has no home ID or X-plate because: n Coming out of county deed records
<br /> ❑Other:
<br /> Manufacturer:Fleetwood I Model: Trinidad 14522S Year:2020
<br /> Manufacturer serial number I HUD number
<br /> FLE210OR20-20853A
<br /> *Number of sections:1- *Square footage: 710 *Number of bedrooms: 2 *Number of bathrooms: 1
<br /> *Type of roofing:Arch,. Comp.*Type of siding: Vert. Cemenf*Heating: Electric *Cooling: None
<br /> *Date of sale: 02/17/2020 *Sales price: 52,285.00 I *Includes land: ❑ Yes M 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 /> jThis 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): I Dealer signature: Date:
<br /> Alta Cima Corp. `1, �lCehara.M 07/02/2020
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<br /> •.. �e,zr.$L'3.is..<..,t etn .it.,n.teaaw.rt t ,,..:u,f'Y7,'.F..>.;4J ' #art„..•cn.z rJ,--s."y 4 J�s .,,..n ,vki..^t �..-S1,F�w;r_ .ir.ra�.?r., .4eYt' L, -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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