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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 q�7 j� 7, UL ®ie�2_ County:, <br /> Gee :�� cs� /' <br /> ❑ Dealer lot Dealer name: Dealer license number: L <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? ❑Yes n No <br /> Changing from: to: <br /> Home transfer by inheritance? n Yes 0 No If yes, attach appropriate Inheritance Affidavit(Form 2946 or 5177) <br /> 1: <br /> Home transfer due to foreclosure? ❑ Yes n No If yes, attach Affidavit of Repossession(Form 3926) <br /> Home transfer through abandonment process? n Yes n No If yes, attach Abandonment Affidavit(Form 2951) <br /> Home transfer through divorce,trust, or right.of survivorship? El Yes 0 No If yes, attach Change Affidavit <br /> (Form 5221) <br /> BUYER/NEW OWNER INFORMATION (one name per box) <br /> Buyer/new owner n e (Last,first, middle): Buyer/new owner name (Last,first, middle): <br /> ir4c .9 17( <br /> Mailing address: A Mailing address: <br /> / 292 fey' - <br /> 1 cLu rpr )/ ?7 <br /> 2 <br /> Phone number: 3..77 e39 Phone number: <br /> Email address: Email address: <br /> (tee. fr'O CLO/, Ca>PkL- <br /> BuYer/new owner name (Last,first, middle): Buyer/new owner name (Last,first, middle): <br /> Mailing address: 31 Mailing address: <br /> 3 4 <br /> ❑ Same as above •t. ❑ Same as above <br /> Phone number: Phone number: <br /> Email address: Email address: <br /> 440-2952(7/19/COM) Page 3 <br />