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CURRENT LOCATION INFORMATION (including city, state, ZIP) <br /> Current location: 15362 Hillcrest Lane NE, Silverton OR 97381(fka 4613 Madrona Hts) 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 /> IF BEING MOVED, LOCATION CHANGES (including city, state, ZIP); <br /> New location: J. '/7 Paz.6.7,4e �,L� ( ,A0/'„„z_ County: ' �� <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: Christopher Deckelmann, Sharon Deckelmann <br /> Are you changing the name of an existing owner? n Yes n 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? n Yes n No If yes,attach Affidavit of Repossession(Form 3926) <br /> Home transfer through abandonment process? n Yes 0 No If yes, attach Abandonment Affidavit(Form 2951) <br /> •f If yes, attach Change Affidavit <br /> Home transfer through divorce,trust,or right of survivorship? ❑Yes n No (Form 5221) <br /> BUYER/NEW OWNER INFORMATION (one name per box) <br /> Buyer/new owner na e (Last,first, middle): Buyer/new owner name (Last,first, middle): <br /> c -1 (.>j 17( <br /> Mailing address: r% Mailing address: <br /> /�9a- fes, 144 <br /> 1 CLU r© Mk--I ok 2 • <br /> Phone number: 3..797_615-3, Phone number: <br /> Email address: Email address: <br /> 001) Oti iiytQ ezv/o - <br /> Bu er/new owner name (Last,first, middle): Buyer/new owner name (Last,first, middle): <br /> Mailing address: 3i Mailing address: <br /> 3 4 <br /> ❑ Same as above x ❑ Same as above <br /> Phone number: Phone number: <br /> Email address: Email address: <br /> 440-2952(7/19/COM) Page 3 <br />