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DocuSign Envelope ID:BC82F0C2-F6EE-4E[._dCS8-F05F91E29D16 1447112 CURRENT LOCATION INFORMATION (including city, state,ZIP) Current location;. • �- I y .k..),,..54.Dr. NE. -�'73Z�(coon 0 Dealer lot 1 Dealer name: Dealer license number:;: Q Park name(if applicable); Out-of-state/federal or tribal property location: IF BEING MOVED,LOCATION CHANGES(including city,state,ZIP) New location:J7 22,14 + �(� t (a ]. L� y 1 DR.q 7355 (County: meiti Q Dealer lot,.!Dealer name: ort j Dealer license number: Park name(if applicable): Out-of-state/federal or tribal ro location: __. P PertY ocahon: - OWNER Current owner names: — ____________i Are you changing the name of an existing owner? D Yes r No Changing from: _ to: • Home transfer by inheritance? 111 Yes 74 No )f yes,attach appropriate Inheritance Affidavit(Form 2946 or 5177) Home transfer due to foreclosure? No If yes,attach Affidavit of Repossession(Form 3926) Home transfer through abandonment process? El Yes ® No If yes,attach Abandonment Affidavit(Form 2951) Home transfer through divorce,trust,or right of survivorship?• 11 Yes 0-No If yes,attach Change Affidavit --" (Form 5221) i- BUYER/NEW OWNER INFORMATION(one name per box) Buyer/new owner name(Last,first, middle): -"" -- Johnstone Robert ) Buyer/new owner name (Last,first, middle): Mailing address; Mailing address: 1 2 Phone number: (Phone number:Email address: IEmail address: Buyer/new owner name(Last,first,middle): Buyer/new owner name(Last,first,middle): — Mailing address: ______ - 3 Mailing address: ID Same as above a []Same as above Phone number: Phone number: Email address: Email address: 440-2952(7/19/COM) OR Title Application-102019-TitleApp11211 Page 3 044489498-00002