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i <br /> • <br /> ccL....„--- <br /> MANUFACTURER'S STATEMENT OR CERTIFICATE OF ORIGIN TO A MANUFACTURED HOME <br /> FIRST ASSIGNMENT <br /> Manufacturer: Cavco Manufacturing,LLC:Cavco Woodburn 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 /> and certifies that the home is new and has not been registered in this or any other state;he also warrants <br /> Street,City,State,and Zip 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 /> The undersigned MANUFACTURER hereby certifies that the new manufactured home described below, Dated at <br /> the property of said MANUFACTURER,has been transferred <br /> By: <br /> This 21 st day of January , 2026 on Invoice 2025095507500 Transferor(Firm Name) Sign Here Position <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 arc true and correct. <br /> D1srr?buror Denier,Etc. Subscribed and sworn to before me this day of , <br /> Notary Public for County,State of <br /> Whose Address PO BOX 547 Notaryseal <br /> Sweet SECOND ASSIGNMENT <br /> SHE RI DAN,OR 97378 For Value Received,the undersigned hereby transfers this Statement of Origin and the manufactured <br /> home described therein to: <br /> City,State,and Zip Address <br /> and certifies that the home is new and has not been registered in this or any other state;he also warrants <br /> Series: Pure Homes 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; 210PU28483U Body Width Ft: 26'B" <br /> Body Length Ft; 52'0" /Ft: 48'0" Dated , at <br /> Including Hitch Excluding Hitch By: <br /> Transferor(Firm Name) Sign Here Position <br /> Square Feet: 1279 Date of Manufacture: 01/19/2026 Dealer License(Permit)No. <br /> Before me personally appeared who by me being <br /> Manufacturer's ID No: CAV2100R25-25382A Weight 17,060 duly sworn upon oath says that the statements set forth above are true and correct. <br /> Subscribed and sworn to before me this day of <br /> Manufacturer's ID No: CAV2100R25-25382B Weight 16,170 Notary Public for County,State of <br /> Manufacturer's ID No: Weight Notary Seal <br /> Manufacturer's ID No: Weight THIRD ASSIGNMENT <br /> 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 /> Manufacturer's ID No: Weight Address <br /> and certifies 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 /> Cavco Manufacturing, LLC •Cavco Woodburn Dated at <br /> Corporation <br /> By: <br /> Transferor(Firm Name) Stgu Here Position <br /> By: <br /> Dealer License(Permit)No. <br /> �� ti ,A �°� Before me personally appeared who by me being <br /> Sign Name tt e or Position 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, <br /> • <br /> Office Address ofSignatory(City&Stale) <br /> State of <br /> Notary Seal <br /> Form Revision Disc; 11/10/2025 <br />