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DocuSign Envelope ID:D92A96DD-4956-4999-A5B7-F98DBB19D7E7
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<br /> Current location: 550 SW BOOTH BEND ROAD ' County: YAMHILL
<br /> Dealer lot Dealer name: FACTORY EXPO HOMES Dealer license number: MSS382
<br /> ❑Park name(if applicable):
<br /> Out-of-state/federal or tribal property location:
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<br /> New location:5037S Cumberland Ct. SE Salem OR 97306P * i County:Marion
<br /> ❑Dealer lot Dealer name: Dealer license number:
<br /> ❑Park name(if applicable):
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<br /> Current owner names: Factory Expo Homes
<br /> Are you changing the name of an existing owner? ❑Yes Ej No
<br /> Changing from: to:
<br /> Home transfer by inheritance? ❑ Yes j No If yes,attach appropriate Inheritance Affidavit(Form 2946 or 5177)
<br /> Home transfer due to foreclosure? ❑Yes Q No If yes,attach Affidavit of Repossession(Form 3926)
<br /> Home transfer through abandonment process? ❑Yes 0 No If yes,attach Abandonment Affidavit(Form 2951)
<br /> Home transfer through divorce,trust,or right of survivorship? ❑Yes Q No If yes,attach Change Affidavit
<br /> (Form 5221)
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<br /> Buyer/new
<br /> owner name(Last,first, middle): Buyer/new owner name(Last,first, middle):
<br /> Cooley-Newberry, Pamela, Jane
<br /> Mailing address: Mailing address:
<br /> 5037 Cumberland Ct. SE
<br /> V, Salem OR 97306
<br /> Phone number: Phone number:
<br /> •; 503-371-7468
<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(7/17/COM) Page 3
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