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<br /> Current location: 3 (a6c, 5� •r/c/1 c .J 6O",t Cc ,h,
<br /> 0 f cr30-73 County:C\Qe4q,vr", •
<br /> ❑ Dealer lot Dealer name: lt3 Dealer license number:
<br /> ❑ Park name (if applicable):
<br /> Out-of-state/federal or tribal property location: \ ii��Y�
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<br /> New location: Z 1 it/ Jciritc,t,s.. rk/. 6, 66je5 01 Cja-3Yt6 County: /Ct. X ivn
<br /> ❑ Dealer lot Dealer name: li 18 Dealer license number:
<br /> ❑ Park name(if applicable): •
<br /> -
<br /> Out-of-state/federal or tribal property location:
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<br /> Current owner names: (Oa j (? . /Pe /( j
<br /> Are you changing the name of an existing owner? ❑ Yes No -
<br /> Changing from: to:
<br /> Home transfer by inheritance? n Yes Z No If yes, attach appropriate Inheritance Affidavit(Form 2946 or 5177)
<br /> Home transfer due to foreclosure? n Yes g.No : If yes, attach Affidavit of Repossession(Form 3926)
<br /> Home transfer through abandonment process? ❑Yes [No If yes, attach Abandonment Affidavit(Form 2951)
<br /> If yes, attach Change Affidavit
<br /> Home transfer through divorce,trust, or right of survivorship? ❑Yes K No • (Form 5221)
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<br /> Buye /new o/wner. name (Last first, middle): Buyer/new owner name (Last,first, middle):
<br /> kft1 .t rtc.k_)Z 4t beak _
<br /> Mailing address: r Mailing address:
<br /> I 4/ (�) ((ce G/w y Gn th /nom:CI)
<br /> 1 °/ y3-11� 2
<br /> Phone number:otnl` 1/1 1723 D'f�`Q' Phone number:
<br /> Email address: Email address:
<br /> Buyer/new owner name (Last,first, middle): ' Buyer/new owner name (Last,first, middle):
<br /> Mailing address: Mailing address:
<br /> 3 4
<br /> ❑ Same as above ❑ Same as above
<br /> Phone number: Phone number:
<br /> Email address: Email address:
<br /> 440-2952(7/17/COM) Page 3
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