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Docusign Envelope ID:48A16631-3385-4EB4-AAD4-7F1FDF37F022 <br /> SECTION 1 NATURE OF FILING(check all that apply) <br /> ❑■ New home to MHODS ICA I.cirier..tec[nitfgsa2a=aner cfrA3 to ate: ) <br /> t6i4 sale ISI.-.CbrAttellirstorage <br /> ❑ Security interest change of feAl-pfdpertatus Trip Permit <br /> •/ -4.raus9 biti eTtitRkce L a te): <br /> SECTION2 �u - APPLICANT INFORMATION (please.print) . � <br /> ❑Dealer/Seller ❑Lender ❑Escrow/Title Agent ❑Owner/Buyer ❑Legal Representative <br /> Name:Alta Cima CorpBA: FactoryExpo Homes Phone:503-980-3990 <br /> (first,middle, last) pp <br /> Address:2555 Progress Way <br /> city:Woodburn 0 State:OR zIP:97071 <br /> Email:agarcia@factoryexpohom es.com <br /> SECTION 3 HOME INFORMATION(information in bold is required) <br /> Home ID#: NEVI OR No Home ID: ■❑New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:FLEETWOOD (01 l 3 a3 <br /> Model:WINNEPEG 210PU244443U Year:2025 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> FLE2100R24-24451A ORE 566889 <br /> FLE2100R24-24451B ORE 566890 <br /> #of Sections: 2 . Sq.footage: 1026 Bedrooms: 3 Bathrooms: 2 <br /> Roofing type: ARCH COMP Siding type: LAP SIDING Heating type: ELECTIC Cooling type: NONE <br /> Date of sale: 10/16/2024 Sale price: $85,740.00 Includes land: ❑Yes ❑� No <br /> gapplicable) <br /> -_SECTION.4 - . DEALER INFORMATION (leave blank if no dealer) <br /> Name. <br /> Alta Cima CorpBA: FactoryExpo Homes License#:MSD448 <br /> (first,middle, last) pp <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 all mortgages,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: Date:03/05/2025 <br /> SECTION 5 �' ' HOME LOCATION <br /> Current Address:2555 Progress Way <br /> City:Woodburn County:Marion State:OR zip:97071 <br /> Park Name: (f applicable) ❑■ This is a dealer lot or storage facility <br /> ❑■ This home is being moved to a new location Complete the section below <br /> New Address:9195 Portlyand Rd NE#4 <br /> City:Salem County:Marion State:OR Zip:97305 <br /> Park Name: (if applicable) Green Oaks Mobile Park ❑This is a dealer lot or storage facility <br /> Transporter Name: Blue Haul Transportation Phone: 503-980-3990 <br /> Address:38681 Garden Dr City: Scio State: OR <br /> Email: blue.haul@yahoo.com <br /> Page 2 <br />