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<br /> Current location:2445 S Pacific Blvd Albany, OR 97321 County:Linn
<br /> ❑Dealer lot Dealer name: Dealer license number:
<br /> ❑Park name(if applicable):
<br /> Out-of-state/federal or tribal property location:
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<br /> •
<br /> New location:6331 Brush Creek DR Silverton, OR 97381 County:Marlon
<br /> ❑Dealer lot Dealer name: Dealer license number:
<br /> ❑ Park name(if applicable):
<br /> Out
<br /> -of-state/federal or tribal property location:
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<br /> Current owner names: J&M Homes, LLC
<br /> • Are you changing the name of an existing owner? ❑Yes n 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`? ❑Yes ❑■ No If yes,attach Affidavit of Repossession(Form 3926)
<br /> Home transfer through abandonment process? ❑Yes 17 No If yes,attach Abandonment Affidavit(Form 2951)
<br /> Home transfer through divorce,trust,or right of survivorship? ElYes 0 No If yes, attach Change Affidavit
<br /> (Form 522])
<br /> �t, F`�.�aiF Yy
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<br /> Buyer/new owner name(Last,first,middle): Buyer/new owner name(Last,first,middle):
<br /> Hazel Brush creek Farms, LLC
<br /> Mailing address: Mailing address:
<br /> PO Box 276
<br /> 1 Hubbard,OR 97032 2
<br /> Phone number: Phone number:
<br /> 503-982-8030
<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(7/17/COM) Page 3
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