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DocuSign Envelope ID:5975253C-EFEF-4E6B-91 F5-1440C90B0464 <br /> CURRENT LOCATION INFORMATION (including city, state, ZIP) <br /> Current location:2555 Progress Way, Woodburn, OR 97071 County:Marion <br /> ❑� Dealer lot Dealer name:Factory Expo Home Centers Dealer license number:MSD448 <br /> ❑Park name(if applicable): <br /> Out-of-state/federal or tribal property location: <br /> IF BEING MOVED, LOCATION CHANGES (including city, state, ZIP) <br /> New location:22314 River Rd. NE#4, St. Paul, OR 97137 County:Marion <br /> ❑ Dealer lot Dealer name: Dealer license number: <br /> ❑ Park name(if applicable): <br /> Out-of-state/federal or tribal property location: <br /> OWNER <br /> Current owner names: Alta Cima Corp <br /> Are you changing the name of an existing owner? ■ Yes n No <br /> Changing from:Dealer to:Owner <br /> Home transfer by inheritance? n Yes n No If yes, attach appropriate Inheritance Affidavit(Form 2946 or 5177) <br /> Home transfer due to foreclosure? n Yes n No If yes, attach Affidavit of Repossession(Form 3926) <br /> Home transfer through abandonment process? n Yes n No If yes, attach Abandonment Affidavit(Form 2951) <br /> Home transfer through divorce,trust, or right of survivorship? n Yes ■ No If yes, attach Change Affidavit <br /> (Form 5221) <br /> BUYER/NEW OWNER INFORMATION (one name per box) <br /> Buyer/new owner name (Last,first, middle): Buyer/new owner name (Last,first, middle): <br /> Mosher, Phil <br /> Mailing address: Mailing address: <br /> 4822 SW Shattuck Rd. <br /> 1 Portland, OR 97221 2 <br /> Phone number: Phone number: <br /> 503-550-7337 <br /> Email address: Email address: <br /> pamosher@me.com <br /> Buyer/new owner name (Last,first, middle): Buyer/new owner name (Last,first, middle): <br /> Mailing address: Mailing address: <br /> 3 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 <br />