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C.URRENTLOCATION'INFORMATION (includingcity,state,ZIP).. <br /> Current location:3838 PALM HARBOR DR NE, MILLERSBURG, OR 97321 County:LINN <br /> ❑� 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 /> • <br /> IF BEING MOVED,;LOCATION CHANGES (including city,.0-tate, ZIP).. <br /> New location:699 CENTRAL ST., GATES, OR 97346 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 /> OWNER <br /> -------_-Cur-rent owner-names: HOMES...DIREC-T--OF-OREGON- ---__----- ---------- —_.. <br /> • <br /> Are you changing the name of an existing owner? n Yes E No <br /> Changing from: to: <br /> Home transfer by inheritance? n Yes- 1-1 No If yes, attach appropriate Inheritance Affidavit(Form 2946 or 5177) <br /> Home transfer clue to foreclosure? ❑ Yes n No If yes,attach Affidavit of Repossession(Form 3926) <br /> Home transfer through abandonment process? n Yes n 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 n No (Form 5221) <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 /> WEST, HOWARD WEST, TRACEY <br /> Mailing address: Mailing address: <br /> 699 CENTRAL ST SAME <br /> 1 GATES, OR 97346 2 <br /> Phone number: , Phone number: <br /> 949.295.2795 <br /> Email address: Email address: <br /> h)oWarcd v,i2pr sh..,COYrL- <br /> Buyer/new owner name (Last,first, middle): Buyer/new owner name (Last,first, middle): <br /> Mailing address: Mailing address: <br /> 3 . 4 <br /> • <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 />