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DocuSign Envelope ID:FD02A388-17EA-4B60-9C59-B3F3FFB2336F <br /> CURRENT N INFORMATION (includlnd city, state,'ZIP) <br /> Current location:655 Pioneer Rd Dallas, OR 97338 County:Polk <br /> El Dealer lot Dealer name: Dealer license number: • <br /> LI Park name(if applicable): <br /> Out-of-state/federal or tribal property location: <br /> Fit El <br /> New location:4735 Turner Rd SE Salem, OR 97317 County:Marlon <br /> CI Dealer lot Dealer name: Dealer license number: <br /> • <br /> E]Park name(if applicable): <br /> Out-of-state/federal or tribal property location: <br /> OWMR <br /> Current owner names:Ken &Tina Hamel <br /> Are you changing the name of an existing owner? LI Yes El No <br /> Changing from:Ken &Tina Hamel to:Factory Homes Clearance Center Inc <br /> Home transfer by inheritance? LI Yes LI No If yes,attach appropriate Inheritance Affidavit(Form 2946 or 5177) <br /> Home transfer due to foreclosure? III Yes rj No If yes,attach Affidavit of Repossession(Form 3926) <br /> Home transfer through abandonment process? El Yes LI No If yes,attach Abandonment Affidavit(Form 2951) <br /> If yes,attach Change Affidavit <br /> Home transfer through divorce,trust,or right of survivorship? El Yes EiNo <br /> (Form 5221) <br /> BUYER/NEW OWNR 1NFOMATION (ore name per box) <br /> Buyer/new owner name(last,first, middle): Buyer/new owner name(Last,first,middle): <br /> Factory Homes Clearance Center Inc <br /> Mailing address: Mailing address: <br /> PC Box 2176 <br /> Tualatin, OR 97062 <br /> 1 2 <br /> Phone number: Phone number: <br /> 971-224-2244 • <br /> Email address: Email address: <br /> Janetm@gunnerlic.com <br /> Buyer/new owner name(Last,first, middle): Buyer/new owner name(Last,lint, middle): <br /> Mailing address: Mailing address: <br /> 3 4 <br /> LI Same as above LI Same as above <br /> Phone number: Phone number: <br /> • <br /> Email address: Email address: <br /> 440-2952(7/19/COM) Page 3 <br />