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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 /> 0 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 J . 3418 "Nim tt q Lv 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? n Yes Tel No <br /> Changing from: to: <br /> Home transfer by inheritance? n Yes (U] No If yes,attach appropriate Inheritance Affidavit(Form 2946 or 5177) <br /> Home transfer due to foreclosure? Yes • 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? n Yes n No If yes, attach Change Affidavit <br /> (Form 5221) <br /> BpUYER/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 />