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r <br /> , <br /> CURRENT LOCATION INFORMATION (including city, state, ZIP) <br /> Current location: cs\'J (? Jt Kb 9e L -6, O i' 9-1303 County: V _A.01\1 <br /> ❑ Dealer lot Dealer name: Dealer license number: <br /> ❑ Park name(if applicable): <br /> Out-of-state/federal or tribal property location: <br /> . . ..1F BEING MOVED, LOCATION CHANGES (including city, state, ZIP) ..1,,= • , <br /> New location: County: <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: "pc)) <br /> yyr <br /> Are you changing the name of an existing owner? n Yes ,/No • <br /> Changing from: to: <br /> Home transfer.by inheritance? ❑ Yes j No If yes, attach appropriate Inheritance Affidavit(Form 2946 or 5177) <br /> Home transfer due to foreclosure? 17 YesNo If yes, attach Affidavit of Repossession(Form 3926) <br /> 7,--- <br /> Home transfer through abandonment process? Yes,No If yes, attachAbandonment Affidavit(Form 2951) <br /> Home transfer through divorce,trust, or right of survivorship?. n Yes o If yes,attach Change Affidavit <br /> (Form 5221) <br /> T; BUYER/NEW OWNER INFORMATION (one name per box) <br /> B, er/new owner name(Last,first,_middle): Buyer/new owner nameiLasst(_fir t, middle): <br /> �.• 1 raM 1110�e V C 1 .--U-16t �OL"'Q)111 ill 0 Mb I() <br /> Mailing addr (� aa � Mailing addres . r <br /> �S� lV 'Ko� I J6 CIS-GT W1 Ute' Art • <br /> 1 & foe ,6` 2 (Sa. lent 0 C: �3o3 <br /> Phone number: Phone number: <br /> 3 03-9 -0Lcs3 <br /> Email ddress: Email address: <br /> Buyer/n'v owner name(Last,-iri' iddle): Buyer/new owner name (Last,first, middle): <br /> • <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 /> 1I <br />