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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:9581 Broadacres Rd, Hubbard, OR 97032 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 /> • <br /> OWNER <br /> Current owner names: <br /> Are you changing the name of an existing owner? ❑Yes 0 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? n Yes II No If yes,attach Affidavit of Repossession(Form 3926) <br /> Home transfer through abandonment process? ❑Yes n No If yes,attach Abandonment Affidavit(Form 2951) <br /> Home transfer through divorce,trust,or right of survivorship? ElYes 0 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 /> Palacios,Alberto <br /> Mailing address: Mailing address: <br /> 9581 Broadacres Rd <br /> 1 Hubbard, OR 97032 2 <br /> Phone number: Phone number: <br /> 503-869-5258 <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/i7/COM) Page 3 <br />