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GURki 16OkridiO Fo ' MATION`( ncluding city,stag, <br /> Current location:3838 PALM HARBOR DR NE, MILLERSBURG, OR 97321 County:LINN <br /> 0 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 /> t <br /> IF BEIM{ I `o ; _ D► r0 .ION OHANOkS�''(including city, s t r.Z) )'`' ; , <br /> New location:11198 CROSBY RD NE,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 /> 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? ❑ Yes ❑Q 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 Q No If yes No attach Change Affidavit <br /> (Form 522 I) <br /> BUYER/NEW OWNER INFORMATION(one name per boxy <br /> Buyer/new owner name(Last,first, middle): Buyer/new owner name(Last,first, middle): <br /> MOTA,ALFRED MOTA,ANDREA, RESSIE <br /> Mailing address: Mailing address: <br /> 11198 CROSBY RD NE SAME <br /> 1 WOODBURN, OR 97071 2 <br /> Phone number: Phone number: <br /> 503-990-3981 <br /> Email address: Email address: <br /> Buyer/new owner name(Last,first, middle): Buyer/new owner name(Last,fust, 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 />