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^"t `gici,,.7#..it s ,„ <br /> k O TIw-N inc!�ie c .4 I ;) <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 properly location: <br /> 4" ifirr EI G 0 / 6Utre 1bHANGi=$ (incl gcit�r, P <br /> New location:3760 Sunshine Circle#28 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 /> a#+- 3 ..: ,. <br /> ya a�3. 1• axe' <br /> -P/ 3 tR ., a � <br /> +x^I'.�.r.i.�._� z��,a�,.g^�,3 ,N'�"- '9�. , �y �+.�Y`f <br /> Current owner names: J & M Homes, LLC <br /> Are you changing the nate of an existing owner? ❑ Yes C No <br /> Changing from: to: <br /> Home transfer by inheritance? E. Yes 11 No If yes,attach appropriate Inheritance Affidavit(Form 2946 or 5177) <br /> Home transfer due to foreclosure? Li Yes Li] 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 ❑I No If yes,attach Change Affidavit <br /> (Form 5221) <br /> t 'sa a �Ftra r ca°� T'IQIa'�sr; ngA <br /> �x <br /> Buyer/new owner name(Last,fist, middle): Buyer/new owner name (Last,first, 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,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 />