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(;-• tO A1p4R N) A U-trO Ct <br /> Docusign Envelope ID:76C34F11-773C-4524-9437-793BF599CA10 <br /> SECTION 1 NATURE OF FILA,G,(clied all that apply) - <br /> M New home to MHODS \LIAkdelactl 1.1611:18 n1.1pner rftrori(9ate: ) <br /> sa e 'IK__ResarkiriNs-reci‘Reg: ty a—GerKeed-te-16-ragti <br /> Seufty interest change leaeitilNfrrnipeThyo pe status 1E Trip Permit <br /> étItance <br /> , -SECTION 2 - APPLICANT INFORMATION (please print) , <br /> ['Dealer/Seller LI Lender 0 Escrow/Title Agent 0 Owner/Buyer EJ Legal Representative <br /> (first,middleN'last)Alta Cima Corp DBA: Factory Expo Homes Phone503-980-3990 <br /> , <br /> Address:2555 Progress Way <br /> city:Woodburn State:OR ZIP:97071 <br /> Email:agarcia@factoryexpohomes.com <br /> SECTION'3, %HOME INFORMATION (Information in bold is required) <br /> Home ID#: -‘) OR No Home ID: 111 New Home Out of state home D Leaving County Deed Records <br /> Manufacturer:Fleetwood Co I, I 34--)_. <br /> Model:28604M Year:2025 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> FLE2100R24-24462A <br /> FLE2100R24-24462B <br /> #of Sections: 2 Sq.footage: 1600 Bedrooms: 4 Bathrooms: 2 <br /> Roofing type: 'Arch Comp Siding type: LAP Heating type: Gas Cooling type: None <br /> Date olicaf sale: <br /> 10-17-2024 Sale price: $113,843.00 Includes land: 0 Yes 0 No <br /> af appble) <br /> SECTION 4 DEALER INFORMATION <br /> (leave blank if no dealer) <br /> ' ' <br /> first,middleNanie:last)Alta Cima Corp DBA: Factory Expo Homes License#:MSD448 <br /> ( , <br /> Address:2555 Progress Way <br /> city:Woodburn State:OR ZIP:97071 <br /> Email:agarcia@factoryexpohomes.com Phone:503-980-3990 <br /> I hereby declare this manufactured structure is free and clear of allmortg ages deeds of trust,security interests,and liens.I have the <br /> legal right to sell this manufactured structure or my interest in it. The information listed is true to the best of my knowledge and <br /> belief,and I understand it can be used as evidence in court and is subject to a penalty of perjury. <br /> Signature: Affigle.c.„,a, Date:01/15/2025 <br /> SEtTlOW5' HOME LOCATION <br /> Current Address:2555 Progress Way <br /> City:Woodburn County:Marion State:OR zip:97071 <br /> Park Name: (if applicable) 1=1 This is a dealer lot or storage facility <br /> EIThis home is being moved to a new location Complete the section below <br /> New Address:21966 Airport Rd NE <br /> City:Aurora County:Marion State:OR Zip:97002 <br /> Park Name:(if applicable) ['This is a dealer lot or storage facility <br /> Transporter Name:Blue Haul Transportation Phone: 818-434-5501 <br /> Address:38681 Garden Dr City: Scio State: OR <br /> Email:blue.haul@yahoo.com <br /> Page 2 <br />