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<br /> Current location:2555 Progress Way, Woodburn, OR. 97071 County:Marion
<br /> ❑1! 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 /> AT.ION:��H�AI�GE�s�:Jai�c'Iuefih(y7ct��{�/�
<br /> New location: 180 Clifford Ave. Detroit, OR. 97342 County: Marion
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<br /> ❑Dealer lot Dealer name: Dealer license number:
<br /> ❑ Park name(if applicable): •
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<br /> Current owner names: Alta Cima Corp. •
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<br /> Are you changing the name of an existing owner? Q Yes ❑No
<br /> Changing from:Dealer to:Owner
<br /> Home transfer by inheritance? ❑ Yes n No if yes, attach appropriate Inheritance Affidavit(Form 2946 or 5177)
<br /> Home transfer due to foreclosure? Lf Yes Q No If yes, attach Affidavit of Repbssession(Form 3926)
<br /> Hdme transfer through abandonment process? ❑ Yes n No If yes,attach Abandonment Affidavit(Form 2951)
<br /> Home transfer through divorce,trust,or right of survivorship? Li Yes if 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 /> • Beireis, Steve Beireis, Tresa
<br /> Mailing address: • Mailing address:
<br /> •
<br /> 431 Hill St. SE 4,31 Hill St. SE •
<br /> • 1•. Albany, OR. 97321 2 Albany, OR. 97321
<br /> • Phone number: - Phone number:
<br /> 1'I _2-7-)& - X335
<br /> Email address: Email address:
<br /> •
<br /> Buyer/new owner name(Last,first, middle): Buyer/new owner name(Last,first, middle):
<br /> •
<br /> Mailing address: Mailing address:
<br /> 3 4 V \.
<br /> ❑Same as above ❑Same as above
<br /> Phone number: Phone number:
<br /> •
<br /> Email address: • Email address:
<br /> 440-2952(7/19/CUM) • Page 3
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