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<br /> Current location:2555 Progress Way, Woodburn, OR. 97071 County:Marion
<br /> 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:
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<br /> New location: 19067 Abiqua Rd. NE, Scotts Mills, OR. 97375 County: Marion
<br /> ❑Dealer lot Dealer name: 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 existingowner? ■ YesNo
<br /> g g ❑ 0
<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 0 No If yes,attach Affidavit of Repossession(Form 3926)
<br /> Home transfer through abandonment process? ❑ Yes Q No ff yes,attach Abandonment Affidavit(Form 2951)
<br /> •throu h divorce,trust,or right of survivorship? if yes,attach Change Affidavit
<br /> Home transfer
<br /> through g p ❑ Yes Q No (Form 5221)
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<br /> Buyer/new owner name(Last,first, middle): ' Buyer/new owner name(Las/,first, middle):
<br /> Delany, David for Delany/Family, LLC
<br /> Mailing address: Mailing address:
<br /> 21318 Hazelnut Ridge Rd.
<br /> I. Scotts MIlls,•OR. 97375 2
<br /> •
<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 /> 3 4
<br /> ['Same as above ❑Same as above
<br /> Phone number: Phone number:
<br /> •
<br /> Email address: Email address:
<br /> 440-2952(7/19/COM) Page 3
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