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<br /> :•••;•:;'-',::6' T i ciiadin 'city :stater ZIP ;
<br /> RREidT��L®CATIOiV'6t�F®��A iOf�` n � ) ,.-:, .. .
<br /> � County:Current location: �. y!� � Rls1`� 4,s¢p ,��. �,l, i�' // , D ipJDIP�
<br /> Deg •-l.ii.F'Ts -sual eF:'
<br /> .I�-P-ark name(ifap ): ete?V4E' e 40/i94,2711
<br /> Out-of-state/federal or tribal property location:
<br /> . .' . • IRBEI BEING_MOVED,:LOCATION-CHANGES,(including:cit r,state = P)•-•`k;k
<br /> Zit'' .•-1�'.
<br /> PP,�� ff Coun
<br /> New location: ��.� ,'f���I�?0�7 /'1'(,pJf� .�� C�N-?'�F�j�� �7��� . ty:/�'I4t2/�.d
<br /> cg Dealer lot Dae:--. mb r•
<br /> ArPark name(if applicable): .6A. e.ei� 4,ccs
<br /> Out-of-state/federal or tribal property location:
<br /> •,.r•.r -t,,; u,. J. ` S ,,...:1-'•,-.-,-,r,';-',.'•.•:;f << .. ,i _ •ip , , S-'Vii , +f,'4-.t=ae
<br /> •- -: -::. ti , :OWNER• • • *• ,,.?,.....-,
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<br /> Current owner names ro(VA, � . n .srYN c r ( V(' ;s,,.-;d-4 I c...Ai A- Ke .. ,
<br /> J
<br /> Are you changing the name of an existing owner? ❑Yes; ig No
<br /> Changing from: je.h 4 6 fa . to: 2304/tire.
<br /> Home transfer by inheritance? ❑ Yes , No If yes,attach appropriate Inheritance Affidavit*(Form 2946 or 5177)
<br /> Home transfer due to foreclosure? ❑ Yes N.No If yes,attach Affidavit of Repossession(Form 3926)
<br /> Home transfer through abandonment process? ❑ Yes Z.No If yes,attach Abandonment Affidavit(Form 2951)
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<br /> Home transfer through divorce,trust, or right-of survivorship? ❑ Yes4 No If yes,attach Change Affidavit
<br /> (Form 5221)
<br /> ° _••.BUYER/NEW OWNER IN•FORMA•T• ION':(one''name'pea'box) ' ' ;Yi•,p ` .;-.••-4•:,-';,,•401;•4,%•. •
<br /> Buyer/new owner name (Last,_first, middle): Buyer/new owner name(Last,first,middle):
<br /> -a * -SO"e-A serr_J0-E.I,C1 e Vh'd cl r.e. tJ n M . .
<br /> Mailing address: i Mail' g address:
<br /> "RI. .130,k a.7
<br /> 1 4y- , Dg . . ?735fG 2 _
<br /> Phone number:. _A.?y-,.q 74 Phone num•er:
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<br /> Email address: ; Email address.
<br /> Ti0.Sg�i 5;61 ' Cin sa'.. 070/91 .
<br /> Buyer/new owner name(Last,first, middle): ' . Buyer/new owner na • • (Last,first, middle):
<br /> Mailing a•dress: Mailing addres
<br /> 3 4
<br /> ❑ Same as pli I've . ❑ Same .s above •
<br /> Phone number: ' Phon• umber:
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<br /> Email address: . Email address:
<br /> 440-2952(7i17ICOM) Page 3
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