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• <br /> CURRENT,.LOCATION INFORMATION (including city, state;ZIP) <br /> Current location:2445 Pacific Blvd SW,Albany, Or 97321 County:Linn <br /> ❑Dealer Iot Dealer name: Dealer license number: <br /> . i <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:20776 Ablqua Rd NE,Scotts Mills, Or 97375 County:Marion <br /> ❑Dealer lot Dealer name: Dealer license number: <br /> El Park Park name(if applicable): <br /> Out-of-state/federal or tribal property location: j <br /> O <br /> Current owner names: <br /> Are you changing the name of an existing owner? ❑ Yes N No <br /> Changing from: to: <br /> Home transfer by inheritance? ❑ Yes Q No If yes,attach appropriate Inheritance Affidavit(Form 2946 or 5177) <br /> Home transfer due to foreclosure? ❑Yes C 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 /> If yes, attach Change Affidavit <br /> Home transfer through divorce,trust,or right of survivorship? ❑Yes Q No (Form 5221) <br /> • BUYER/NEW:OWNER INFORMATION (ane name per box) • <br /> Buyer/new owner name(Last,first, middle): Buyer/new owner name (Last,first, middle): <br /> Shane Fitzke <br /> Mailing address: Mailing address: <br /> 20776 Abiqua Rd NE <br /> 1 Scotts Mills, Or 97375 2 <br /> Phone number: Phone number: <br /> 503-871-7587 <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 /> 0 Same as above 0 Same as above <br /> Phone number: Phone number: <br /> Email address: Email address: <br /> 440-2952(7/19/COM) Page 3 <br />