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CURRENT LOCATION INFORMATION (including city, state,ZIP) - - <br /> Current location: �' (' Jam' V�t(� G t 5h eri A012 9137 U County:•Pp t K <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: 411 S C by dcal .->Y. -T- <br /> urn-ex,01.2.-ct1 12. County: Mct e <br /> ❑Dealer lot Dealer name: Dealer license number: <br /> 0 Park name(if applicable): <br /> Out-of-state/federal or tribal property location: <br /> OWNER <br /> Current owner names: LAIN V. a L&o16._ F' 73/7min, <br /> Are you changing the name of an existing owner? ❑ Yes ER-go <br /> Changing from: to: <br /> Home transfer by inheritance? ❑ Yes [ 1 o If yes,attach appropriate Inheritance Affidavit(Form 2946 or 5177) <br /> Home transfer due to foreclosure? ❑Yes [2'No If yes,attach Affidavit of Repossession(Form 3926) <br /> Home transfer through abandonment process? ❑Yes Q'4lo If yes,attach Abandonment Affidavit(Form 2951) <br /> Home transfer through divorce,trust,or right of survivorship? ❑Yes EtNo If yes,attach Change Affidavit <br /> (Form 5221) <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 /> G-,13C In vesfl en+s LLG <br /> Mailing address: Mailing address: <br /> LPL( i,dt tk n,►, 2n S <br /> X I 5A44,444 1 e2- 611 3 c L 2 <br /> Phone number: Phone number: <br /> Email address: Email address: <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 ❑ Same as above <br /> Phone number: Phone number: <br /> 'Email address: Email address: <br /> 440-2952(7/17/COM) Page 3 <br />