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} <br /> 'm 5 4* <br /> „'ne,_ r ... { 9>%, ,,a l <br /> • <br /> . , . , wPitt . eq.. 6 „. tA ^''i7r <br /> "•�� <br /> Current location:2555 Progress Way,Woodbum,OR. 97071 County:Marion <br /> Q Dealer lot Dealer name:Factory Expo Homes Dealer license number:MSD 448 <br /> ❑Park name(if applicable): <br /> Out-of-state/federal or tribal property location: <br /> y �NJlx+sal _ a?A to C !1AraMmF <br /> °4e11xeleV, <br /> New location:11420 Rowena Ave.SE,Lyons,OR. 97358 Countyrbin..Marion <br /> ❑Dealer lot Dealer name: Dealer license number: <br /> ❑Park name(if applicable): <br /> Out-of-state/federal or tribal property location: <br /> l' , r .1 n490� � ; s • . n . �� <br /> y <br /> �-411 rni x �� ���. Sy5� ��• <br /> Current owner names:Alta Cima Corp. <br /> Are you changing the name of an existing owner? 0 Yes ❑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? ❑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 0 No If yes,attach Change Affidavit <br /> (Form 5221) <br /> yfr�-r��' '��••� � f,�.�mf a' H �>��rr r �`:�"i, �'.� o <br /> :4,4gr P„!.. 7!H ".' err '' .. 2. .Y” .v�•,:•.1.” _ 9 'C Fr,�d'�-P� :�.K3��;:sG� YI' '� K✓: t...•K_, ..-_ <br /> Buyer/new owner name(Last,first,middle): Buyer/new owner name(Last,first,middle): <br /> Adams, Dennis <br /> Mailing address::: Mailing address: <br /> • 11420 Rowena Ave.SE, <br /> Lyons, OR. 97358 <br /> Phone number: Phone number: <br /> :.' Email address: Email address: <br /> Buyer/new owner,name(Last,first,middle): Buyer/new owner name(Lasi,first,middle): <br /> • <br /> Mailing address::; Mailing address: <br /> 3 <br /> ❑Same as above 0 Same as above <br /> Phone number: Phone number: <br /> Email address: Email address: <br /> 440-2952(7/19/COM) - Page 3 <br /> s ' <br />