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1306214 CURRENT LOCATION INFORMATION(including cit ,state,ZIP) Current location:a t('t5 Lo eau,y l c. .i51vdE dc7.: 'County: L 14.Kr Ei Dealer lot i Dealer name: ealer license number: Park name(if applicable): Out-of-state/federal or tribal property location: IF BEING MOVED,LOCATION CHANGES(Including dity,state,ZIP) }'New location: 7 c 3< 6anGtj.-1 AVE. Si Pcwul 012 �"7,13�1 j C°unty: A(pi i Br E3 Dealer lot Dealer name: Baler license num • 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,/ No Changing from: to: AHome transfer by inheritance? 0 Yes 1:21No If yes,attach appropriate Inheri ance Affidavit(Form 2946 or 5177) III Home transfer due to foreclosure? Ei Yes n"CTo If yes,attach Affidavit of Il a ossession(Form 3926) � Home transfer through abandonment process? 0 Yes No If yes,attach Abjndonment Affidavit(Form 2951) Home transfer through divorce,trust,or right of survivorship? ❑Yes[ No I yes,attach Change Affidavit (Form 5221) BUYER/NEW OWNER INFORMATION(one name per box) Buyer/new owner name(Last,first, middle): B jer/new owner name(Last,firs,middle): So ,.fh4r((in f. %,-rteC- t 1 r,r ,;`f,to Mailing address: 35 LLo e jah)hb� AVt Mailing address: 3 Se-(d 81cnc%a d-Ave. 1 ct-P air 3 i --• + 2 _� __ S> Phone number: c� i i_ 15_ 02_7_o — Phone number: I(.1--i i_ 5 u 3- 62 Z o Email address: htt'LI r� Email address: _At�o�#�Cryt (,u, \03,101,..�;a VI, tlt"►>�Y(AYIcz�0.svti(w t ii(hi}oD. i Buyer/new owner name(Last first, middi): Buyer/new owner name(Last,first,middle):- Mailing iddle):- Mailing address: I Mailing address: I 3 ; 4 F3 Same as above 0 Same as above 1 Phone number: Phone number: Email address: i Email address: 440-2952(7117/COM) OR Title Application-12/2017-TiticAppl 1211 Page 3 004085888-00002 11