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UocuSign Envelope ID:67C8F4D6-8AEA-4767-AC47-6ED2F2F2F3CA <br /> CURRENT LOCATION INFORMATION (including city, state, ZIP) <br /> Current location: 2555 Progress Way, Woodburn, OR. 97071 County: Marion <br /> 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 /> IFEEINO fil OVED,.LOCATION CHANGES (including city, state; ZIP) <br /> New location: 11160 Stockpile Lane SE, Stayton, OR. 97383 County: Marion <br /> ❑ Dealer lot Dealer name: Dealer license number: <br /> ❑ Park name(if applicable): <br /> Out-of-state/federal or tribal property location: <br /> Current owner names: Alta Cima Corp. <br /> Are you changing the name of an existing owner? Q Yes Ti No <br /> Changing from: Dealer to: Owner <br /> Home transfer by inheritance? ❑ Yes ❑� No If yes,attach appropriate Inheritance Affidavit(Form 2946 or 5177) <br /> Home transfer due to foreclosure? ❑ Yes C No If yes, attach Affidavit of Repossession(Form 3926) <br /> Home transfer through abandonment process? n Yes n No If yes. attach Abandonment Affidavit(Form 2951) <br /> Home transfer through divorce,trust,or right of survivorship? ❑ Yes Q No If ons, attach Change Affidavit <br /> (Form 5221) <br /> BUYER/NEW OWNER INFORMATION (one name per box) <br /> Buyer/new owner name (Last,first, middle): Buyer/new owner name (Last,first, middle): <br /> Messick, Mike Messick, Katherine <br /> Mailing address: Mailing address: <br /> 11160 Stockpile Lane SE 11160 Stockpile Lane SE <br /> i Stayton, OR. 97383 2 Stayton, OR. 97383 <br /> Phone number: 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 <br />