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<br /> L Dealer/seller 0 Lender ❑Escrow/title agent ❑ ;
<br /> 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(f known): DMV X-plate number(if known):
<br /> tvCW m359Baj
<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:Fleetwood • I Model:Wellington 28482R I Year:2021
<br /> Manufacturer serial number.'. I HUD number ' .
<br /> FLE2100R20-21039A
<br /> FLE210OR20-21039B •
<br /> *Number of sections: 2 I *Square footage: 12791 *Number of bedrooms: 2 I *Number of bathrooms: 2
<br /> *Type of roofing: Arch. Comp.' *Type of siding:Vert. Cement I *Heating: Electric I *Cooling: None
<br /> *Date of sale: 01/20/2020 I *Sales price: 65,391 00 I *Includes land:❑Yes XNo
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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. Naito.,D'( anat4/I 10/09/2020
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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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