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<br /> Current location:2555 Progress Way,Woodburn, OR. 97071 County:Marion
<br /> El Dealer Iot 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: 260 Frontier Dr. Gates, OR, 97346 County: Marion
<br /> ❑Dealer lot Dealer name: Dealer license number:
<br /> ❑Park name(ifapplicable):
<br /> Out-of-state/federal or tribal property location:
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<br /> Current owner names: Alta Cime Corp.
<br /> Are you changing the name of an existing owner? 0 Yes n No
<br /> Changing from:Dealer to:Owner
<br /> Home transfer by inheritance? ❑ Yes 0 No If yes, attach appropriate inheritance Affidavit(Form 2946 or 5177)
<br /> Home transfer due to foreclosure? [1 Yes U No if yes,attach Affidavit of Repossession(Form 3926)
<br /> Home transfer through abandonment process? ❑ Yes ©No If yes,attach Abandonment Affidavit(Form 2951)
<br /> Home transfer through divorce,trust,or right of survivorship? If yes,attach Change Affidavit
<br /> p 1 t glYes❑ Ln No (Form 5221)
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<br /> Buyer/new owner name(Last,first, middle): Buyer/new owner name(Last,first, middle):
<br /> Gonzales, Gilbert Gonzales, Randi
<br /> Mailing address: Mailing address:
<br /> 234 Sandy Lane 234 Sandy Lane
<br /> li Keizer,-OR. 97303 2 Keizer, OR, 97303
<br /> Phone number: Phone number:
<br /> 503-899-8594 503-899-8594
<br /> Email address: Email address:
<br /> randiandben@gmail.com randiandben@gmail.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
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