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• CURRENT LOCATION INFORMATION (including city, state,ZIP) <br /> Current location:FLEETWOOD HOMES-2655 PROGRESS WAY,WOODBURN, OR 97071 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 /> IF BEING MOVED, LOCATION CHANGES(Including city, state, ZIP) • <br /> New location: , NE-SCOTTS MILLS,OR 97375 County:MARION <br /> address is: 3995 Crooked Finger Rd NE Dealer license number: <br /> ❑Dealer lot Dealer name: per Marion County Building Permit <br /> • <br /> ❑Park name(if applicable): <br /> Out-of-state/federal or tribal property location: <br /> OWNER <br /> Current owner names: CASCADE FACTORY HOMES,INC, <br /> • <br /> Are you changing the name of an existing owner? []YesO❑No <br /> Changing from: to: <br /> Home transfer by inheritance? ❑ Yes Q No If yes,attach appropriate Inheritance Affidavit(Form 2946 or 517,7) <br /> Home transfer due to foreclosure? ❑Yes E No If yes,attach Affidavit of Repossession(Form 3926) <br /> Home transfer through abandonment process? ❑Yes []No If yes,attach Abandonment.Affidavit(Form 295I) <br /> rdivorce,trust,or right of survivorship? Yes ❑i No If yes,attach Change Affidavit ! <br /> Home transfer through h ❑ <br /> Ho e 8 P <br /> 8 Form 5221 <br /> ( ) <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 /> SPLONSKI,LEONARD J. . . <br /> Mailing address: Mailing address: • <br /> 3993 CROOKED FINGER RD, NE • <br /> 1 SCOTTS MILLS, OR 97375 2 <br /> Phone number: Phone number: <br /> 503-551-7358 <br /> Email address: Email address: <br /> SPLONSKI8@GMAIL.COM <br /> Buyer/new owner name(Last,first, middle): Buyer/new owner name(Last,first, middle): • <br /> SPLONSKI, KAREY • <br /> Mailing address: Mailing address: <br /> • <br /> 3 4 <br /> Q Same as above ❑Same as above <br /> Phone number: Phone number; <br /> 503-873-4199 <br /> Email address: Email address: <br /> KSPLONSKI@GMAIL.COM • la _ <br /> 440.2952(7/17/COM) Page 3 • <br />