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CURRENT LOCATION INFORMATION,(including city, state, ZIP) ;a <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,'LOCATION CII'ANGES (including city; state,.ZIP) :- ,._ ., , . <br /> New location: r // l/r e cce �v � (0'J ' 7-75.9/, ' County: /14-44,..."--,t <br /> -❑Dealer lot Dealer name: 11 . <br /> Dealer license number: <br /> Park name (if applicable): Doer Cye..eR ' 4o ho'J <br /> Out-of-state/federal or tribal property location: <br /> ,,. . 'OWNER ':_ _ ,, . .� . <br /> � <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 El 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 0 No If yes, attach Abandonment Affidavit(Form 2951) <br /> If yes, attach Change Affidavit <br /> Home transfer through divorce,trust,or right of survivorship? <br /> F ! - <br /> No (Form 5221) <br /> BUYER/NEW OWNER INFORMATION (one namperb <br /> Yox) <br /> e ; <br /> 4' ' <br /> ` k . <br /> Buyer/new owner name (Last,first, middle): Buyer/new owner name (Last,first, middle): <br /> _ Flay <br /> Mailing address: Mailing address: <br /> 1 C . OW g 7 j y 6 2 <br /> Phone number: q , 7/-9 te 14 v Phone number: <br /> Email address: <br /> Ema address:// K �/ <br /> Pi�, B r y6�+21 e)14„:A 02yL' <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 />