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1308365 (1•�,py by (( TYa_OC� T t��11V1� 1nei _ , F,� . N. . . QR �G� _urn `�c�, .,��#�te,��P) x � Current location: County: ' 1 gl Dealer lot Dealer name:� // r� Dealer license number: tt J ��f 0 Ps' s3 i4sv 5• rLl A ' 0 Park name(if applicable): Out-of-state/federal or tribal property location: �l-F-1B.EING M VE�('}b,.LOCATION',iLJ'4Ai GE$(ir+cludln ci ,state,2tP) r , New location: (1' 1 V e t- 1!!11 rn- Qe St j vet -or`1 Q1z-c 7 3 T/ County: nIty 0 Dealer lot Dealer name: Dealer Iicense number: 0 Park name(if applicable): Out-of-state/federal or tribal property location: OWNER; Current owner names: BA_R.13 kiut LA)/Ncier bct v.,, ZS 7-4:7--e-- Are 4:7--cAre you changing the name of an existing owner? [Yes N]No Changing from: to: Home transfer by inheritance? Yes No If yes,attach appropriate Inheritance Affidavit(Form 2946 or 5177) Home transfer due to foreclosure? 0 Yes IC No If yes,attach Affidavit of Repossession(Form 3926) Home transfer through abandonment process? 0 Yes [I,No If yes,attach Abandonment Affidavit(Form 2951) Home transfer through divorce,trust,or right of survivorship? 0 Yes E No If yes,attach Change Affidavit (Form 5221) `: BUYERINEW OWNE}INFORMATJON(once name pervbox) Buyer/new owner name(Last,first,middle): Buyer/new owner name(Last,first,middle): Mailing address: 1;87 V1 c-ice 1-4,1 N �'-J Mailing address: 1 Sh-verion ,0/2. 3 Y,g1 2 Phone number: S-03.41 .0-.7 8 13 Phone.number: Email address: Email address: Buyer/new owner name(Last,first,middle): Buyer/new owner name(Last,first,middle): Mailing address: Mailing address: 3 4 Q Same as above . Same as above Phone number: Phone number: Email address: Email address: 440-2952(7/17/COM) OR Title Application-10/2018-TitleApp11211 Page 3 004107394-00002