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CURRENT L"Oc'A •TION INFORMATION (includ ng city, state, ZIP)` <br /> Current location:400 W. Elm Ave. Hermiston, Or 97321 County:Umatilla <br /> [' Dealer lot Dealer name: Dealer license number: <br /> ❑ Park name(if applicable): _- <br /> Out-of-state/federal or tribal property location: <br /> µ, I,F zBEING.M;OVED;'LOCATION. CHANGES;'(lncludmg city, state,'ZIP) <br /> New Location:3097 Rainbow Spc#3 Hubbard, Or 97032 County:Marion <br /> ❑ Dealer lot Dealer name: Dealer license number: <br /> ❑ Park name(if applicable):Hoodview Senior Estates <br /> Out-of-state/federal or tribal property location: <br /> n <br /> WNE <br /> Current owner names: J & M Homes, LLC <br /> Are you changing the'tante of an existing owner? ❑ Yes Q No <br /> Changing from: to: <br /> Home transfer by inheritance? n Yes n 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 ❑m No If yes,attach Abandonment Affidavit(Form 2951) <br /> Home transfer through divorce,trust, or right of survivorship? ElYes Q No If yes, attach Change Affidavit <br /> (Form 5221) _ 1. <br /> BUYER/NEW OWNER INFORMATION (one name,per box) <br /> Buyer/new owner name (Last,first, middle): Buyer/new owner name (Last,,Trst, middle): <br /> Mailing address: Mailing address: <br /> 1 2 <br /> Phone number: Phone number: <br /> Email address: Email address: <br /> Buyer/new owner name(Last,•rrst, 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 /> • <br /> Email address: Email address: <br /> 440-2952(7/17/CON4) Page 3 <br />