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DocuSign Envelope ID:E5F4F394-4698-4584-A44D-BD1128BF958F
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<br /> Current location: 550 SW BOOTH BEND ROAD County:YAMHILL
<br /> El Dealer lot I 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:4940 Sunnyside Road SE spc K3 Salem OR 97302 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 Q No
<br /> Changing from: to:
<br /> Home transfer by inheritance? n 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 If yes,attach Abandonment Affidavit(Form 2951)
<br /> If yes,attach Change Affidavit
<br /> Home transfer through divorce,trust,or right of survivorship? ❑Yes 0 No (Form 5221)
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<br /> Buyer/new
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<br /> Buyer/new owner name(Last,first,middle): Buyer/new owner name(Last,first, middle):
<br /> Williams, Robert, Leroy Williams, Karen,Elizabeth
<br /> •, Mailing address: , Mailing address:
<br /> • 2200 Lancaster Dr. SE spc 6B 2200 Lancaster DR. SE spc 6B
<br /> • 1:;: Salem OR 97317; 2 Salem Or 97317
<br /> Phone number: Phone number: .
<br /> 503-871-5593 503-871-5593
<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 /> Email address: Email address:
<br /> •
<br /> 440-2952(7/17/COM) Page 3 .
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