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<br /> Current location:2555 Progress Way, Woodburn, OR. 97071 County:Marion
<br /> 0 Dealer lot Dealer name:Factory Expo Homes Dealer license number:MSD 448
<br /> ❑Park name(if applicable);
<br /> Out-of-state/federal or tribal property location:
<br /> e �aWWitt: Y. � %.**T
<br /> 1@i <: ? ` r
<br /> New location: 745 NE Alder St. Mill City, OR. 97360 County:l_rinit Marion
<br /> ❑Dealer lot I Dealer name: I Dealer license number:
<br /> ❑Park name(if applicable):
<br /> Out-of-state/federal or tribal property location:
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<br /> Current owner names:Alta Cima Corp.
<br /> Are you changing the name of an existing owner? Ei Yes ❑No
<br /> Changing from:Dealer to:Owner
<br /> Home transfer by inheritance? ❑Yes Q No If yes,attach appropriate Inheritance Affidavit(Form 2946 or 5177)
<br /> Home transfer due to foreclosure? ❑Yes iJ No If yes,attach Affidavit of Repossession(Form 3926)
<br /> Home transfer through abandonment process? ❑Yes 0 No If yes,attach Abandonment Affidavit(Form 2951)
<br /> Home transfer through divorce,trust,or right of survivorship? ElYes [}No If yes,attach Change Affidavit
<br /> (Form 5221)
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<br /> Buyer/new owner name(Last,first, middle): Buyer/new owner name(Last,first, middle):
<br /> Busby, Steve Busby, Kathy
<br /> Mailing address: Mailing address:
<br /> PO Box 845 PO Box 845
<br /> 1Mill City, OR. 97360 2 Mill City, OR. 97360
<br /> Phone number: Phone number:
<br /> Email address: Email address:
<br /> Buyer/new owner name(Last,,first, middle): Buyer/new owner name(Last,first, middle):
<br /> Mailing address: Mailing address:
<br /> 4
<br /> ❑Same as above ❑Same as above
<br /> Phone number: Phone number:
<br /> Email address: Email address:
<br /> 440-2952(7/19/COM) Page 3
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