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an <br /> • <br /> 1257865 <br /> Current location; a i7 l[Z't1b 09-9M� I County: L1 b' n <br /> El Dealer lot Dealer name: Dealer license number.a'1-1 <br /> 0 Park name(if applicable): <br /> Out-of-state/federal or tribal property location: <br /> New location: <br /> Q Dealer lot Dealer name: ' j Dealer license number: <br /> [l Park name(if applicable): <br /> Out-of-state/federal or tribal property location: <br /> V <br /> Current owner names: <br /> Are you changing the name of an existing owner? D Yes [J No <br /> Changing from; to: <br /> Home transfer by inheritance? 0 Yes ZINo If yes,attach appropriate Inheritance Affidavit(Form 2946 or 5177) <br /> Home transfer due to foreclosure? 0 Yes EaQo If yes,attach Affidavit of Repossession(Form 3926) <br /> Home transfer through abandonment process? Yes lNO If yes,attach Abandonment Affidavit(Form 2951) <br /> Home transfer through divorce,trust,or right of survivorship? []Yes.2 No If yes,attach Change Affidavit <br /> (Form 5221) <br /> $uy r/new,owner nam Last,first m' dle): Bye ne swner n, a firs middle) <br /> ckd P C'-1-C"'w7 <br /> Mallin address: Malwinp,,a dress: <br /> / I C ..e 4,,,ef SrI 9:2_34- /� ? C'> rrdc 4. 7 <br /> Phone number:y sy?ii.-7(a/2 Phone number: <br /> 563— 62 13 --1(5/0 <br /> Entail address: t. b_e. it addc <br /> eit <br /> Buyer/new owner name(Last,first,middle): Buy/new owner name(Last,first,middle): <br /> Mailing address: Mailing address: <br /> 3 4 <br /> LI Same as above fl Same as above <br /> Phone number: Phone number: <br /> Email address: Email address: <br /> 440-2952(7/17/COM) <br /> OR Title Application-122017-TitleApp11211 Page 3 003971290-00009' <br />