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CURRENT LOCATION INFORMATION (inclu_ding city, state,ZIP)° <br /> Current location:105 Forest Avenue, Detroit, OR 97342 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 /> IF BEING MOVED,:LOCATIONrCHANGES (including city;state, ZIP)', F . <br /> New location: r/ ��f_-__,.,6‘,1-c--,1:,,,,,,„ - y C% ,,;Kl✓z/A County: ./14a4.„.." <br /> r <br /> ❑ Dealer lot Dealer name: <br /> Dealer license number: <br /> NO Park name(if applicable): Oe ev. CY e-e V . 4(5 6l 4'J <br /> Out-of-state/federal or tribal property location: <br /> . <br /> `OWNER <br /> Current owner names: Joetta L Evans <br /> Are you changing the name of an existing owner? ❑ Yes 0 No <br /> Changing from: to: <br /> Home transfer by inheritance? ❑ Yes 0 No If yes, attach appropriate Inheritance Affidavit(Form 2946 or 5177) <br /> Home transfer due to foreclosure? ❑ Yes j 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 /> If yes, attach Change Affidavit <br /> Home transfer through divorce,trust, or right of survivorship? ❑ Yes Q No (Form 5221) <br /> f <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 /> g1- 4� ,tit' Don <br /> Mailing address: , Mailing address: <br /> 2 if-4- tiJii-14 <br /> 1 6 ,t. fr2) OW g7-?1/ 6 • 2 <br /> Phone number: 1,7/ 719 `P 9 4v- Phone number: <br /> Erna* / �taddresssi / Bir yitni / ` 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: j Email address: <br /> 440-2952(7/17/COM) Page 3 <br />