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CURRENT:LOCAT,ION 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 /> ❑Park name(if applicable): <br /> Out-of-state/federal or tribal property location: <br /> IF:aIN..G;'MOVED,`LOCATION=CHANGES (including.'city ;state,~ZIP:}` <br /> New location:779 NE Santiam Blvd Mill City, Or 97360 <br /> Y County:Marrion <br /> ❑Dealer lot Dealer name: Dealer license number: <br /> . I <br /> ❑Park name(if applicable): <br /> Out-of-state/federal or tribal property location: <br /> OWNER::: <br /> Current owner names: <br /> • j <br /> Are you changing the name of an existing owner? ❑Yes E No <br /> Changing from: to: <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 ❑■ No If yes,attach Affidavit of Repossession(Form 3926) <br /> Home transfer through abandonment process? ❑Yes ❑■ No If yes,attach Abandonment Affidavit(Form 2951) <br /> Home transfer through divorce,trust,or right of survivorship? ❑Yes ENo If yes No attach Change Affidavit <br /> (Form 5221) <br /> :BUYER/NE OV11 <br /> Buyer/new owner name(Last,first, middle): Buyer/new owner name (Last,first, middle): <br /> Warriner, Korbin Warriner, Sirinya <br /> Mailing address: Mailing address: <br /> 779 NE Santiam Blvd 779 NE Santiam Blvd <br /> Mill City,Or 97360 2 Mill City, Or 97360 <br /> Phone number: Phone number: <br /> 509-949-2272 509-949-2272 <br /> Email address: Email address: <br /> bigk777@gmail.com bigk777@gmail.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 ❑ Same as above <br /> Phone number: Phone number: <br /> Email address: Email address: <br /> 440-2952(7/17/COM) Page 3 <br /> ' i <br />