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CURRENT LOCATION INFORMATION (including city, state, ZIP) <br /> Current location:2445 Pacific Blvd SW,Albany, OR 97321 County:Linn <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:26302 Sitkum St SE, Lyons, OR 97358 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 /> OWNER <br /> Current owner names: <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? ❑Yes 1 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 /> Home transfer through divorce,trust, or right of survivorship? Yes n 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 /> Aggen, Robert, 0 Aggen, Loretta, A <br /> Mailing address: Mailing address: <br /> 26302 Sitkum Rd 26302 Sitkum Rd <br /> 1 Lyons, OR 97358 2 Lyons, OR 97358 <br /> Phone number: Phone number: <br /> 971-240-8098 p 971-240-8098 <br /> Email address: Email address: • <br /> fishinmama60@gmail.com fishinmama60@gmail.com <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/COM) Page 3 • <br />