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CURRENT LOCATION INFORMATION (including city; state, ZIP) <br /> Current location: 3838 Palm Harbor Drive, Millersburg, OR 97321 County: Linn County <br /> ❑� Dealer lot Dealer name: Homes Direct of Oregon LLC Dealer license number:MSD-S23 <br /> ❑ 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:2348 Willa , Lane SE, Lyons, OR 97358 County: Marion <br /> ❑ Dealer lot Dealer name: S ipj 3488 j 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? ❑ Yes ❑■ No <br /> Changing from: to: <br /> Home transfer by inheritance? ❑ Yes ❑1 No If yes, attach appropriate Inheritance Affidavit(Form 2946 or 5177) <br /> Home transfer due to foreclosure? n Yes 0 No If yes,attach Affidavit of Repossession(Form 3926) <br /> Home transfer through abandonment process? ❑ Yes n No If yes,attach Abandonment Affidavit(Form 2951) <br /> Home transfer through divorce,trust,or right of survivorship? ['Yes ❑■ No If yes,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 /> Roggia, Irene <br /> Mailing address: Mailing address: <br /> PO Box 489 <br /> 1 Lyons, OR 97358 2 <br /> Phone number: Phone number: <br /> 971-707-3348 <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 />