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CURRENT LOCATION INFORMATION (including city, state, ZIP) <br /> Current location:3838 PALM HARBOR DR NE, MILLERSBURG, OR 97321 County:LINN <br /> Q 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 /> IF BEING MOVED, LOCATION CHANGES (including city, state, ZIP) <br /> New location:3788 STARLIGHT DR NE, SILVERTON, OR 97381 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: HOMES DIRECT OF OREGON <br /> Are you changing the name of an existing owner? ❑ Yes ❑■ No <br /> Changing from: to: <br /> Home transfer by inheritance? LI Yes 0 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 ❑■ No If yes, attach Abandonment Affidavit(Form 2951) <br /> Home transfer through divorce,trust,or right of survivorship? _ Yes ❑1 No If yes,attach Change Affidavit <br /> (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 /> ALTSULER,STEVE ALTSULER, SANDY <br /> Mailing address: Mailing address: <br /> PO BOX 1086 SAME <br /> 1 SILVERTON, OR 97381 2 <br /> Phone number: Phone number: <br /> 501-655-3558 <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 <br />