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Mar 12 20,01:36p Dougs.Mobile Home Service 503-200-1299 p.3� <br /> Current location: '� ., �at�s s �Ee, I . <br /> 0 Dealer lot Dealer name: -- � �7 `�� count ,� <br /> --_, - 1 <br /> ❑Park name ifa Dealer license number: <br /> ppli£able): <br /> Out-of-state/federal or tribal property location: <br /> • IF BEING NIVE;Di.LOCATIOW <br /> )G New location: q Egeickdh � 9 �� q ZIP)�9.�6i°�bg.•�YiS�- <br /> ❑Dealer lot Dealer name: g ... <br /> �� County: { <br /> I 0 Park name(if appiicabie): Dealer license ltuinber: <br /> Out-of stateifederal or n-ibal property location: -OWNER <br /> Current owner names: <br /> 1 <br /> - c-e C'. 6pn- - • <br /> • <br /> / <br /> I Are you chatlrlg the nalt?e of an existing <br /> €owner? ❑� Yes l i!NoChanging from: <br /> Horne transfer b to: <br /> Y inheritance? ❑ Yes <br /> No 'ryes,attach appropriate Inheritance <br /> Horne transfer due to i'oreclasu>e? ❑y� El No Affidavit iso <br /> ❑ if les,attach Affidavit of Repossession - rm 9�6 or 5177) <br /> Home transfer through abandonment process? r r; r (conn 39?6 f <br /> 0 Yes �No �yes,attach Abaildon_ineLt Affidavit <br /> Home transfer througl,divorce, trust,or right of survivorship?� ,� _ (Foi'g 29jI 1 <br /> g tors_,-.A• ❑Yes [�1]No t;yes, a#tach Change=�frida��it <br /> i�uJ�'Et�/�Ei/'!f'b Q,OEr�'��'�iN �>;� orrn X21) <br /> • Buyer/new o ,alfa:�nOlki ;one r, <br /> owner 1lCTST.first,Sy Iltl[lGT/2 m .r'I.i_� C'S'1.77,-,:g) <br /> i �: <br /> j(t,h to L a e -Z :t�e:lze5�owner name(Last,first, middle): <br /> 1';��a>lt't3g address: • - •adle): <br /> J <br /> Mailing address: <br /> �0 c K �.:2-3 'u,;e c k '...�-T Cir �cs� 2 �; <br /> Phone number:: <br /> .1 3 t <br /> I s `�- `Pt 742 I Mme Lie" ' ,, <br /> Email address: <br /> e i, 1% jl� <br /> f <br /> o Email act <br /> . .,,,. <br /> Buyer/new rle�v owner name(Las,first, middle):, . I °�r, -P_ . , . •, . f`•= - '-1!Buyer/new. owner - c <br /> name(Last,first,-m(Idle): <br /> , t <br /> i <br /> Pilaf/ring address: f <br /> Mailing adess: <br /> ❑Same as above 4 <br /> Phone number: -: <br /> -mail address: <br /> Prriall address: <br /> 10-2952(7/17/COM) <br /> Page 3 <br />