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CURRENT LOCATION INFORMATION (including city, state, ZIP) <br /> Current location: y 5 5 N nit 1.t, L n. 1 0 (Y I11�n�v,\�.t �i`1t�f ounty: ill h i?( <br /> ❑Dealer lot Dealer name: Dealer license number: <br /> ❑Park name(if applicable): Q l U•I�Q <br /> ne 1 <br /> Out-of-state/federal or tribal property location: <br /> IF BEING MOVED, LOCATION CHANGES (including city, state, ZIP) <br /> New location: 4155 Lancaster Dr NE#44 Salem, OR 97305 County: Marion <br /> ❑.Dealer lot f Dealer name: Dealer license number: <br /> I[]Park name(if applicable): Chemeketa MV <br /> Out-of-state/federal or tribal property location: <br /> OWNER <br /> Current owner names: v u a qe � S �tw L,LC II <br /> Are you changing the name of an existing owner? 13g Yes ❑No <br /> Changing from: v;ti a�e Wmes Nw 1.1..G to: o r-i 7 <br /> urn . 1 <br /> Home transfer by inheritance? ❑YesNo If yes,attach appropriate Inheritance Affidavit(Form 2946 or 5177) ff <br /> Home transfer due to foreclosure? ❑Yes. 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,No If yes,attach Change Affidavit <br /> (Form 5221) <br /> BUYER/NEW OWNER INFORMATION (one name per box) <br /> Buyer/new owner name(Last,first, middle): Buyer/new owner name(Last,first, middle): <br /> Toriz, Juan <br /> Mailing address: Mailing address: <br /> 4155 Lancaster Dr NE <br /> 1 Salem, OR 97305 2 <br /> Phone number: Phone number: <br /> 503.954.7705 <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(7/19/CO214) . Page 3 <br />