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CURRENT LOCATION INFORMATION (including city, state, ZIP) <br /> Current location:33964 OAKVILLE RD SW ALBANY OR County:LINN <br /> • Dealer lot Dealer naine:LEISURELAND HOMES INC Dealer license nutnber:MS D119 <br /> E] Park name(if applicable): <br /> Out-of-state/federal or tribal property location: <br /> IF BEING MOVED, 1LOCATION CHANGES (incjudingcity;-state,.ZIP).1'.: <br /> New location:2067 DRIFT CREEK RD SILVERTON OR 97381 County:MARION <br /> Dealer lot Dealer name: , Dealer license number: <br /> El Park name (if applicable): <br /> Out-of-state/federal or tribal property location: <br /> OWNER .• <br /> Current owner names: • <br /> LEISURELAND HOMES INC • <br /> Are you changing the name of an existing i owner? Ili Yes No <br /> Changing from:LEISURELAND HOMES INC to: KEN ROTH <br /> Home transfer by inheritance? E Yes El No If yes, attach appropriate Inheritance Affidavit(Form 2946 or 5177) • <br /> Home transfer due to fordclosure? Yes El No If yes,attach Affidavit of Repossession (Form 3926) <br /> Home transfer through abandonment process? n Yes I No If yes, attach Abandonment Affidavit(Form 2951) <br /> If yes, attach Change Affidavit <br /> Home transfer through divorce, trust,or right of survivorship? Yes I No <br /> (Form 52l) • <br /> i • <br /> . 7 BUYER/NEW OWNER INFORMATION (one name per box) <br /> Buyer/new owner name (Last,first, Middle): Buyer/new owner name (Last,first, middle): <br /> ROTH, KEN <br /> Mailing address: Mailing address: <br /> 14479 EVANS VALLEY RD • <br /> SILVERTON OR 97381 <br /> 1 2 <br /> Phone number: Phone number: <br /> 503-930-9581 • <br /> • <br /> Email address: Email address: <br /> Buyer/new owner*Ile (Last,first, Middle): Buyer/new owner name (Last,first, middle): <br /> • <br /> Mailing address: Mailing address: <br /> 3 4 <br /> El Same as above rj Same as above <br /> Phone number: Phone number: <br /> 'Email address: Email address: • <br /> 440-2952(7/19/COM) Page 3 <br /> 1 <br />