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<br /> Current location:3838 PALM HARBOR DRIVE MILLERSBURG OR 97321 County:LINN
<br /> 0 Dealer lot Dealer name:HOMES DIRECT OF OREGON LLC Dealer license number MSD 523
<br /> ❑Park name(if applicable):
<br /> Out-of-state/federal or tribal property location:
<br /> i.
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<br /> New location: �5 71 1 n f /Ly 0f o_r v z- Op Coun :Pkr i� \
<br /> 0 Dealer lot Dealer name: [411111(14 Dl / koO^,O(0 f Dealer license number: �f.5'
<br /> 6 -1�1<i
<br /> ❑Park name(if applicable):
<br /> Out-of-state/federal or tribal property location:
<br /> d . r, ��X � rxi 1 i S � I 1 rc > p t - 7 5� .- 3 r s )ti- [ ) t Y'4
<br /> � 7 `t "1 f x .OWNER > k '` i + ss+'_rSKr : i„tiy?{ x} x 2
<br /> Current owner names:
<br /> Are you changing the name of an existing owner? n Yes )No
<br /> Changing from: to:
<br /> Home transfer by inheritance? ❑ Yes [` No If yes,attach appropriate Inheritance Affidavit(Form 2946 or 5177)
<br /> Home transfer due to foreclosure? ❑Yes 5 No If yes,attach Affidavit of Repossession(Form 3926)
<br /> . Home transfer through abandonment process? ❑Yes [A-No If yes,attach Abandonment Affidavit(Form 2951)
<br /> If
<br /> Home transfer through divorce,trust,or right of survivorship? n Yes �,No yes,attach Change Affidavit
<br /> (Form 5221)
<br /> *., :,
<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 /> ,
<br /> Pe,-1-suv\ , Iran 4- •
<br /> Mailing address: Mailing address:
<br /> X511 orpoAX-, 2
<br /> SC
<br /> .- 1 L CP(N& 115 6113%
<br /> Phohe number: Phone number:
<br /> q i1 315 S5gq
<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 /> 4
<br /> ❑Same as above ❑ Same as above
<br /> Phone number: Phone number:
<br /> Email address: Email address:
<br /> •
<br /> 440-2952(7/19/COM) Page 3
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