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• <br /> MANUFACTURER'S STATEMENT OR CERTIFICATE OF ORIGIN TO A MANUFACTURED HOME <br /> FIRST ASSIGNMENT <br /> Manufacturer. Cavco Manufacturing,LLC: Cavco Woodbum For Value Received,the undersigned hereby transfers this Statement of Origin and the manufactured <br /> home described therein to: <br /> Address: 2655 Progress Way,Woodburn,OR 97071 Address <br /> Street City,Starr!and Zip and certifies that the home is new and has not been registered in this or any other slate;he also warrants <br /> i the title of said home at time of delivery.subject to the liens and encumbrances,if any.as set out below <br /> u Amt.Of Lien Date To Whom Duo Address <br /> • <br /> Tnc undersigned MANUFACTURER hereby certifies that the new manufactured home described below, Dated at <br /> the property of said MANUFACTURER,.has been transferredBy: `, <br /> This 27th day of June , 2025 ' on Invoice 2025095848800 Thanifemr(Firm Namc) Sign Here Position i <br /> Dealer License(Permit)No. <br /> Before me personally-appeared who by me being <br /> To: ADJ ENTERPRISES. INC. dba:SHERIDAN.FACTORY HOMES duly sworn upon oath says that the statements set forth above are true and correct. <br /> Distri6utar,Drake,Etc. Subscribed and sworn to before me this day of , <br /> II Notary Public for County,Slate of <br /> Whose Address PO-BOX 547 I NorarySeal <br /> Suers SECOND ASSIGNMENT <br /> For Value Received,the undersigned hereby transfers this Statement of Origin and the manufactured <br /> SHERIDAN,OR 97378 home described therein to: <br /> CITY.State.and hp Address <br /> and certifies that the homc.is new and has not been registered in this or any other state;he also warrants <br /> Series: Pure Homes t Model Year, 2026 the title of said home at time of delivery,subject to the liens and encumbrances,if any,as set out below <br /> Amt.Of Lien Date To Whom Due Address <br /> Model No: 210PU24443U Body Width Ft: 23'4" — <br /> Body Length Ft: 48'0' /Ft: 44'0" Dated al <br /> Inchrf ng Ifech Excluding Hitch By: <br /> Transferor(Finn Name) Sign Here Position <br /> Square Feet: 1027 Date of Manufacture: 06/27/2025 Dealer License(Permit)No. <br /> Before me personally appeared who by me being <br /> duly sworn upon oath says thatthestatements set forth above arc true and correct. <br /> Manufacturer's ID No: CAV2100R25-24857A Weight 16,660 Subscribed and sworn to before me this day of <br /> Manufacturer's ID No: CAV210OR25-24857E Weight 15,130 Notary Public for County,State of <br /> Manufacturer's ID No: Weight Notary,Seal <br /> THiRD ASSIGNMENT <br /> Manufacturer's ID No: Weight For Value Received,the undersigned hereby transfers this Statement of Origin and the manufactured <br /> Manufacturer's ID No: Weight home described therein to: <br /> ress <br /> Manufacturer's ID No: Weight -_ -- nddcertifies that the home is new and has not been registered in this or any other state;he also warrants <br /> the title of said home at time of delivery,subject to the liens and encumbrances,if any,as set out below <br /> The CORPORATION further Certifies that this was the first transfer of such new manufactured home in Amt.Of Lien Date To Whom Due Address <br /> ordinary trade and commerce. <br /> Cauca Manufacturing,LLC : Cavco Woodburn. Dated1 <br /> By: <br /> • Corpnratlon <br /> Transferor(Firm Name) Sign Here Position <br /> Dealer License(Permit)No. <br /> By: ^' ` c—�V�n�.�� Before me personally appeared who by me being <br /> Sign name Title or-Positron duly sworn upon oath says-that the statements set forth above are true and correct. <br /> 2655 Progress Way,Woodburn,OR 97071 Subscribed and sworn to before me this day of , <br /> Notary Public for County,State of <br /> • (Vire Address rf Signatory(City tt Stair) Notary Seal <br /> . Fore,ttesi]lon Dar J,4411025 <br />