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Oct,. 1. 2021 10:45AM Marion County No, •1095 4/6 <br /> . ; . .,, .CURRENT LOCATION INFORMATION (including city, state, ZIP) , <br /> Current location: t ,736- q'" - a iy� Ts County; ,,,.} <br /> O Dealer lot Dealer name: Dealer license number; <br /> "7 El Park name(if applicable); <br /> Out-of-state/federal or tribal property location: <br /> " ' ' . 1F'BEING MOVED;,LOCATION.CHANGES Including city, state, ZIP) .... . ' <br /> New location: t 0 .1 Lf D i A L C <br /> 4,r fi ;�g- County: "4 <br /> 0 Dealer lot Dealer name: 1 Dealer license number: <br /> ❑Park name(if applicable); <br /> Out-of-state/federal or tribal property location: <br /> • <br /> OWNER <br /> Current owner names:- -ti tae,A142. /7,e -5;:ece,dr C ¢ <br /> C. <br /> Are you changing the name of an existing owner? ❑ Yes 'I: No <br /> Changing from: to: <br /> Home transfer by inheritance? 0 Yes 4 No If yes, attach appropriate Inheritance Affidavit(Form 2946 or 5177) <br /> Home transfer due to foreclosure? ❑Yes Q No If yes,attach Affidavit of Repossession(Form.3926) <br /> Home transfer through abandonment process? E Yes 4 No 1f yes, attach Abandonment Affidavit(Form 2951) <br /> Home transfer through divorce,trust,or right of survivorship? ❑Yes ®No If yes,attach Change Affidavit <br /> (Form 5221) <br /> BUYER/NEW OWNER.INFORMATION (one name per box) • <br /> • <br /> Bayer/new oner na e(Lr}lt; rtstrn�tidd e : Buyer/new owner name(,Gast,fist, middle): <br /> finN tki 0 k 1 si <br /> Mailing address: l IA^ 401g: Mailing address: <br /> 1 'Ifi 5°q'1-°e,gth OP,4154t(7 . <br /> Phone number; 9, € (,-71..-SO 2I Phone number: <br /> Email address: k address; <br /> Buyer/new owner name(Last,,first, m ddl): 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(7119/COM) Page 3 ' <br />