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<br /> Current location: 550 SW BOOTH BEND ROAD County: YAMHILL
<br /> 0 Dealer lot I Dealer name: FACTORY EXPO HOMES I Dealer license number: MSS382
<br /> 0 Park name(if applicable):
<br /> Out-of-state/federal or tribal property location:
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<br /> New location:7198 River Road NE Keizer OR 97303 I County:Marion
<br /> ❑Dealer lot I Dealer name: I 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: Factory Expo Homes
<br /> Are you changing the name of an existing owner? ❑Yes 0 No
<br /> Changing from: to:
<br /> Home transfer by inheritance? ❑ Yes El 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 0 No If yes,attach Abandonment Affidavit(Form 2951)
<br /> Home transfer through divorce,trust,or right of survivorship? ❑Yes 0 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 /> Piculell, Lee
<br /> Mailing address: Mailing address:
<br /> 702 Hampden Lane NE
<br /> 1 Salem OR 97317 2
<br /> Phone number: Phone number:
<br /> 206-949-9943
<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 /> 0 Same as above ❑Same as above
<br /> Phone number: Phone number:
<br /> Email address: Email address:
<br /> 440-2952(7/17/COM) Page 3
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