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5 3 5 As h �l c.c y >n�►� <br /> Docusign Envelope ID:E6FEB368-5397-4018-AAAC-98E2D9FAF9CF <br /> SECTION 1 NATURE OF FILING (check all that apply)'' .'` <br /> El New home to MHODS r e r ❑VIen t rn(3att;- <br /> e s e ' eecet •iriNs-realipcepet3.y e <br /> c s ❑■ Trip Permit <br /> \Tr.ansfa nce P nr-(please ): <br /> SECTION 2 APPLICANT INFORMATION (please print). , • <br /> ❑■ Dealer/Seller In Lender ❑Escrow/Title Agent ❑Owner/Buyer ❑Legal Representative <br /> Name:Alta Cima CorpBA: FactoryExpo Homes Phone:503-980=3990 <br /> _ (first,middle, last) P p <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#: E OR No Home ID: ❑New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer: Fleetwood 101 4-tj <br /> Model:Harrisburg 28483U Year:2025 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> CAV2100R25-24797A <br /> CAV2100R25-24797B <br /> #of Sections: 2 Sq.footage: 1279 Bedrooms: 3 Bathrooms: 2 <br /> Roofing type: ARCH COMP Siding type: LP SmartSide Siding Heating type: Electric - ' Cooling type: None <br /> Date of sale: 03/18/2025 Sale price: $90,953.00 Includes land: ❑Yes . ❑No <br /> (If applicable) <br /> SECTION 4. DEALER INFORMATION(leave blank if no daler) <br /> Name:Alta Cima CorpBA: FactoryExpo Homes License#:MSD448 <br /> (first,middle, last) p p <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: 4) . Date:05/16/2025 <br /> SECTION 5 HOME LOCATION . . <br /> Current Address:2555 Progress Way <br /> City:Woodburn County:Marion State:OR Zip:97071 <br /> Park Name: (if 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:5375 Ash St <br /> City:Turner County:Marion State:OR Zip:97392 <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 />