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CURRENT LOCATION INFORMATION(inclu:ding.city, state,;ZIP) <br /> Current location: 2655 PROGRESS WAY,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 /> IF BEINGMOVED,.LOCATION CH"ANGES (inC.Iuding city 'state ZIP) <br /> New location:7755 CHECKERBOARD CT, GERVAIS, OR, 97026 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 /> Current owner names: CASCADE FACTORY HOMES, INC. <br /> Are you changing the name of an existing owner? ❑Yes s❑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 Q 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 /> Home transfer through divorce,trust,or right of survivorship? [1] Yes 0 No If yes, attach Change Affidavit • <br /> (Form 5221) <br /> BUYERINEW OWNER;INFORMATION (one• ` name per b'ox) 1. <br /> Buyer/new owner name(Last,first, middle): ' Buyer/new owner name(Last,first, middle): <br /> BECERE,ANNA <br /> Mailing address: Mailing address: <br /> P0BOX 473 <br /> 1 GERVAIS, OR 97026 2 <br /> Phone number: Phone number: <br /> 503-951-3181 <br /> Email address: Email address: <br /> KATCAM 18@GMAI L.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(7/17CON•1) Page 3 <br />