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<br /> ❑Dealer/seller ❑Lender ❑Escrow/title agent Owner/buyer ❑Legal representative
<br /> Name:Robert and Karen Williams
<br /> Address(including city,state,and ZIP):2200 Lancaster Drive SE spc 6B Salem OR 97317
<br /> Phone:503-871-5593
<br /> Email:
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<br /> Home ID number(if known): / DMV X-plate number(if known): j
<br /> TBD NEW M 3( c 57
<br /> Moving in from another state
<br /> Has no home ID or X-plate because: ❑Coming out of county deed records
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<br /> Manufacturer: SKYLINE Model:Lonerock I Year:2021
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<br /> 245-000-H-A100494A C`E SC S %,(f3°
<br /> 245-000-H-Al 00494B r a 551 °S.-1
<br /> *Number of sections:2 I *Square footage:1080 *Number of bedrooms:2 *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 4/1/2020 I *Sales price:60,924.00 *Includes land:❑Yes 0 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 /> 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.
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<br /> Dealer name(print): Dealer �dr¢ Date:nea by: 8/20/2020 I 12:2 PM MST
<br /> Factory Expo Homes eio.t•wor art,
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<br /> Transporter name: Transporter address and phone:
<br /> Superior Home Transport LLC PO Box 1067
<br /> Jefferson OR 97352
<br /> 541-327-7805
<br /> 440-2952(7/17/COM) Page 2
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