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CURRENT.LOCATION INFORMATION (including•city;'state, ZIP) <br /> Current location:3838 PALM HARBOR DR NE, MILLERSBURG,OR 97321 County:LINN <br /> 1J Dealer lot Dealer name:HOMES DIRECT OF OREGON Dealer license number:MSD523 <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:1644 GRANITE DR.,WOODBURN, OR 97071 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 /> Current owner names: <br /> Are you changing the name of an existing owner? ❑Yes Q 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 0 No If yes,attach Affidavit of Repossession(Form 3926) <br /> Home transfer through abandonment process? ❑ Yes Q No If yes,attach Abandomnent Affidavit(Form 2951) <br /> Home transfer through divorce,trust,or right of survivorship? 111Yes •No If yes,attach Change Affidavit <br /> (Form 5221) <br /> BUYER/NEW OWNER`INF,ORMATION (one:.name.per.box). <br /> Buyer/new owner name(Last,first, middle): Buyer/new owner name(Last,firsl, middle): <br /> SEGOVIA, JOSE <br /> Mailing address: Mailing address: <br /> 1644 GRANITE DR <br /> • <br /> 1 WOODBURN, OR 97071 2 - <br /> Phone number: • <br /> Phone number: <br /> • <br /> 503-989-8467 <br /> Email address: Email address: <br /> ana-bauti sta7@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 • ❑Same as above <br /> Phone number: Phone number: <br /> Email address: Email address: <br /> 440-2952(7/17/COM) Page 3 <br />