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. 3 3 9 M E F � , \m�. �l C , -1-N/ et—13 O <br /> . • .CURRENT LOCATION INFORMATION (including city,:state;ZIP.) <br /> Current location:339 NE 5th Ave,Mill City,OR 97360 County:Marlon <br /> .D Dealer lot . Dealer name: .... ... .._...-. . <br /> ., Dealer license number: <br /> Park name(if applicable): <br /> • <br /> Out-of-state/federal or tribal property location: <br /> • •• IF BEING MOVED, LOCATION CHANGES (including•city,state,ZIP) <br /> New location: County: <br /> 0 Dealer lot Dealer name: Dealer license number: <br /> 0 Park name(if applicable): <br /> Out-of-state/federal or tribal property location: <br /> • <br /> OWNER • ' . : . . • <br /> Current owner names: <br /> ,r• <br /> 'Are you changing the name of an existing owner? 0 Yes 0 No • <br /> Changing from: • ••• to: - <br /> Home transfer by inheritance? ❑Yes [/ No If yes,attach appropriate Inheritance Affidavit(Form 2946 or 5177) <br /> Home transfer due to foreclosure? ❑Yes II 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 /> • <br /> Home transfer through divorce;trust,or right of survivorship? 0 Yes 111No If yes,attach Change Affidavit <br /> (Form 5221) <br /> • <br /> • . BUYER/NEW OWNER INFORMATION(one.name per:b•ox) <br /> • Buyer/new owner name(Last,'first,middle): '• Buyer/new owner name(Last,first,middle): <br /> Seidlitz,Douglas,"K • <br /> • <br /> Mailing address: . . , Mailing address: <br /> '::339•NE.5th Ave <br /> ,' Mlii City,OR 97360 . `2`, .m. <br /> Phone number: Phone number: <br /> 541-206-8966 . <br /> Email address: • Email address: <br /> dougseldlitz@rocketmail.com <br /> Buyer/new owner name(Last,first,.middle): ' Bayer/new owner name(Last,first,middle): <br /> Mailing address: • • Mailing address: <br /> 3 .i4 <br /> :❑Same as above ' ' . ' ❑Same as above <br /> Phone number: :Phone number: <br /> Email address: " Email address: <br /> 4402952(7/17/COM) Page 3 • <br />