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DocuSign Envelope ID:99D08FCF-BC7A-4E6D-BB65-DOB4DB7F671A
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<br /> Current location:2555 Progress Way,Woodbum, OR. 97071 County:Marion
<br /> N 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:
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<br /> New location:13400:Bonney Rd. NE, Woodburn, OR. 97071 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:Alta Cima Corp.
<br /> Are you changing the name of an existing owner? j Yes ❑No
<br /> Changing from:Dealerto: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 /> If yes,attach Change Affidavit
<br /> Home transfer through divorce,trust,or right of survivorship? ❑Yes II No (Form 5221)
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<br /> • Buyer/new owner name(Last,first, middle): Buyer/new owner name(Last,first, middle):
<br /> Adamski, Kathryn Douglas, Kelly
<br /> Mailing address: Mailing address:
<br /> 13412 Bonney Rd. NE 13412 Bonney Rd. NE
<br /> >. Woodburn, OR. 97071 2 Woodburn, OR. 97071
<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:
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<br /> 0 Same as above ❑Same as above
<br /> Phone number: Phone number:
<br /> Email address: Email address:
<br /> 440-2952(7/19/Corot) Page 3
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