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1520085 CURRENT LOCATION INFORMATION(including city,state,ZIP) Current location: G AA 14 Alba et 7 -2 qt I?(,c, ; zI va sw AI��„)County: Dealer lot Dealer name: Dealer license number: ❑Park name(if applicable): Out-of-state/federal or tribal property location: IF BEING MOVED, LOCATION CHANGES(including city,state,ZIP) New location: 9(()-2 g 7'a.,-ofL.ane. yey.s, G 973 g County:/14 ri e, [�Dealer lot Dealer name: Dealer license number: 0 Park name(if applicable): Out-of-state/federal or tribal property location: OWNER Current owner names: Are you changing the name of an existing owner? Yes El No Changing from: to: Home transfer by inheritance? Yes Q No If yes,attach appropriate Inheritance Affidavit(Form 2946 or 5177) Home transfer due to foreclosure? D Yes El No If yes,attach Affidavit of Repossession(Form 3926) Home transfer through abandonment process? El Yes Q No If yes,attach Abandonment Affidavit(Form 2951) Home transfer through divorce,trust,or right of survivorship? D Yes El No If yes,attach Change Affidavit (Form 5221) . � BUYER/NEW OWNER INFORMATION (one name per box) Buyer/new owner name(Last,first,middle): Buyer/new owner name(Last,first,middle): Nieto Amy Mailing address: 7157. i t la,i g Mailing address: 1. r�vf.rt 4It 017 so 2 Phone number: 503 t.{u A go g Phone number: Email address: bab`v.j o� a y ej.,o a. G o rv. Email address: Buyer/new owner name(Last,first, middle): Buyer/new owner name(Last,first,middle): Mailing address: Mailing address: 3 4 E Same as above Same as above Phone number: Phone number: Email address: Email address: 440-2952(7/19/COM) OR Title Application-10/2019-TitleApp11211 Page 3 004741491-00001