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CURRENT LOCATION INFORMATION (including city, state, ZIP) <br /> Current location:400 W Elm Ave, Hermiston, OR 97838 County:Umatilla <br /> Dealer lot Dealer name: Dealer license number: <br /> [i]Park name(if applicable): <br /> Out-of-state/federal or tribal property location: <br /> • IF BEING MOVED, LOCATION CHANGES (including city, state, ZIP) <br /> New location:35175 North Fork Rd SE, Lyons, OR 97358 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 /> OWNER <br /> Current owner names: <br /> Are you changing the name of an existing owner? fl Yes El No <br /> Changing from: to: <br /> Home transfer by inheritance? 1-1 Yes No If yes,attach appropriate Inheritance Affidavit(Form 2946 or 5177) <br /> Home transfer due to foreclosure? El Yes Iii No If yes,attach Affidavit of Repossession(Form 3926) <br /> • Home transfer through abandonment process? El Yes [I]No If yes,attach Abandonment Affidavit(Form 2951) <br /> If yes,attach Change Affidavit <br /> Home transfer through divorce,trust,or right of survivorship? 0 Yes No <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 /> Randall, Craig, V Randall,Janice, M <br /> Mailing address: Mailing address: <br /> PO Box 245 PO Box 245 <br /> • 1 Lyons, OR 97358 2 Lyons, OR 97358 <br /> Phone number: Phone number: <br /> 541-405-1458 <br /> Email address: Email address: <br /> cbrandall@yahoo.com <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 D Same as above <br /> Phone number: Phone number: <br /> Email address: Email address: <br /> • 440-2952(7/17/COM) Page 3 <br />