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_ :CURRENT LOCATION INFORMATION,(includi'ng.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 tribalro ert y location: <br /> P P � <br /> IF,BEING:MOVED LOCATION CHANGES includin- 'city' <br /> New location:5422 Portland Ave. NE # 139 Salem, OR 97305 County:Marion <br /> ❑Dealer lot Dealer name: Dealer license number: <br /> I Park name (if applicable): Arrowhead Mobile Home Park <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? [' Yes ❑I■ 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 • No If yes, attach Affidavit of Repossession (Form 3926) <br /> Home transfer through abandonment process? ❑ Yes 0 No If yes,attach Abandonment Affidavit(Form 2951) <br /> Home transfer through divorce, trust, or right of survivorship? n Yes Q No If oes, attach Change Affidavit <br /> (Form 5221) <br /> BUYER/NEW OWNER INFORMATION (one name;per box)f <br /> Buyer/new owner name(Last,first, middle): Buyer/new owner name(Last,first, middle): <br /> Irwin, Eugene. <br /> Mailing address: Mailing address: <br /> 5422 Portland Ave. NE #139 <br /> 1. Salem, OR 97305 .2 <br /> Phone number: Phone number: <br /> 503-385-5118 <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(7/17/COM) Page 3 <br />