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<br /> Current location:2555 Progress Way,Woodbum, OR. 97071 County:Marion
<br /> Dealer lot I Dealer name:Factory Expo Homes I 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: 313 Thistle Down Lane, Gates, OR. 97346 County: Marion
<br /> ❑Dealer lot Dealer name: 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:Alta Cima Corp.
<br /> Are you changing the name of an existing owner? El Yes ❑No
<br /> Changing from:Dealer to:Owner
<br /> Home transfer by inheritance? ❑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 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
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<br /> Buyer/new owner icame(Last,first,middle): ' Buyer/new owner name(Last,first, middle):
<br /> McClain, Ivan JE McClain, Kathy
<br /> Mailing address: Mailing address:
<br /> 880 N. Santiam Hwy. 880 N. Santiam Hwy.
<br /> 2 Gates, OR. 97346
<br /> 1. Gates, OR. 97346 .
<br /> ' Phone number:
<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 /> 440-2952(7/19/COM) Page 3
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