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CURRENT LOCATION INFORMATION(Including city,stale,ZIP) <br /> Current location: 3(04u S4c.<J .c l On )14,bc,i1 Or.. j'7(32 County: in.,. <br /> ❑Dealer lot f Dealer name: I Dealer license number: <br /> ❑ <br /> Park name(if applicable): <br /> Out-of-state/federal or tribal property location:. <br /> IF BEINGPJIOVED,LOCATION CHANGES(includlntj city,state,ZIP) <br /> W Z Aldi",�1� G / S t'�;(ir�o , c V q0 County. :1lt h.-104 <br /> New location: <br /> Dealer lot Dealer name: SIp,fS— Ma_V 4 k 0 Dealer license number: <br /> (fark name(if applicable): VkAll <br /> Out-of-state/federal or tribal property location: <br /> OWNER <br /> Current owner names: <br /> WA-64- 411111iai s —_- <br /> ir�L(�. (6) C ?ht... ikohra-1 a . 6,r c 7131' <br /> Are you changing the name of anexisting.owner? ❑;Yes [ No <br /> Changing from: w to: <br /> Home transfer by inheritance? ❑Yes 0 No If yes,attach appropriate Inheritance Affidavit(Form 2946 or 5177) <br /> Home transfer due to foreclosure? ❑Yes aft No If yes,attach Affidavit of Repossession(Form 3926) <br /> Home transfer through abandonment process? ❑i Yes [►i No If yes,attach Abandonment Affidavit(Form 2951) <br /> Home transfer through divorce,trust,or right of survivorship? ❑Yes El'lffo If yes,attach Change Affidavit <br /> tr <br /> (Form 5221) <br /> BUYER/NEW OWNER INFORMATION(ono name per box) <br /> Buyer/neva owner name(Last,first,middle): Boyer/new owner name(Last,first,middle): <br /> OPW Ar ) 3-Aga <br /> i <br /> I14ieilinga t1as: Mailing address: <br /> 12Q67 I46 q�m� <br /> 1 VA rtflocu:VO- lelA- qS‘(g 2. <br /> Phone number: _gtoq : Phone slumber: <br /> Email address: eAwetra(J . <br /> ct [YYY-111r Email address: <br /> -• <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- .0 Same as above <br /> Phone number: Phone number: - <br /> Email address: :Email address: <br /> 440-2954(7/19/COM) Page 3 <br />