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1293463 CURRENT LOCATION INFORMATION (including city,state,ZIP) Current location: C 2.`A i><S1C. �.`� 5� GR a7( )c3 c'''��a tl County: L 1 Dealer lot 1 Dealer name: CI, Dealer licensenumber: )S 7 0 Park name(if applicable): Out-of-state/federal or tribal property location: IF BEING MOVED, LOCATION CHANGES(including city,state,ZIP) New location: Zci9 q �. 5 �i3a 2 County: iMa 0.1 hl ui t� >v Dealer lot Dealer name: Dealer license number: D 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? 0 Yes Q No Changing from: to: Home transfer by inheritance? 0 Yes:fl No. If yes,attach appropriate Inheritance Affidavit(Form 2946 or 5177) Home transfer due to foreclosure? 0 Yes 0 No If yes,attach Affidavit of Repossession(Form 3926) Home transfer through abandonment process? Yes C No If yes,attach Abandonment Affidavit(Form 2951) Home transfer through divorce,trust, or right of survivorship? 0 Yes Q No If yes,attach Change Affidavit (Form 5221) BUYER/NEW OWNER INFORMATION(one name per box) Buyer/new owner nameLast first, middle): Buyer/new owner name(Last,first, middle): VN ,ales(f•/ DAY-re 1 ( Q 1�c P.,L cr N)--/ P Rci Mailing address: / /,� Mailing[address: C 1 ��y�/ /`:.11 i.vL Com_ C.1't'$ j— LL, /Y�' SCit�lvl : D%� 2 5~C5 Brie a AZ' 1E4,) bi2.173.0.3 Phone number: 730 3 Phone number: 5-03 5 --7 93 6 co3-S6r-ztr Email address: 144 sic.vise 2,7 - • r c Email address: J(r je r?3€?J953 0,9 eL4/ Buyer/new owner name(Last,first, middle): Buyer/new owner name(Last,first, middle): Mailing address: Mailing address: 3 4 0 Same as above Same as above Phone number: Phone number: Email address: Email address: 440-2952(7/17/COM) OR Title Application-12/2017-TitleAppl 1211 Page 3 004073768-00002