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< e(URRENT;LOCATIONINFORfVMATIO Un...... ng city9 state., ZIP)
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<br /> Current location: 15S"a . )'\4/\,,,t,--' ),\s �"-S'
<br /> 11 V'At32(1)012. 003 S R I County: `f,')
<br /> ❑Dealer lot I Dealer name: kla, I Dealer license number:
<br /> 0 Park name(if applicable): tr,lc,
<br /> Out-of-state/federal or tribal property location:
<br /> f,f(j(,
<br /> IFBEING MOVED LOCATION C1HANG$ES 1041 iding city, state, ZIP)
<br /> NQW.19gati°n: I r 7L 'd t,,,,A`X'� a-ei Loo0 9 % ` e l) 0 ._- li 1 .I .County: J arf0A\
<br /> ❑Dealer lot Dealer name: to rt
<br /> I Dealer license number:
<br /> ❑Park name(if applicable): 1(kl a,.,
<br /> Out-of-state/federal or tribal property location: A/a
<br /> „ t •. „.,..te „.�
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<br /> Current owner names:
<br /> )1)3 vt, le'r,z,-,(.0.,
<br /> G, 11, ,-
<br /> Are you c anging the name of an existing owner? ❑Yes 11 No
<br /> Changing from: to:
<br /> Home transfer by inheritance? ❑ Yes V,l , o If yes,attach appropriate Inheritance Affidavit(Form 2946 or 5177)
<br /> Home transfer due to foreclosure? ❑Yes+i);i o If yes, attach Affidavit of Repossession(Form 3926)
<br /> Home transfer through abandonment process? ❑Yes V[No If yes,attach Abandonment Affidavit(Form 2951)
<br /> If yes,attach Change Affidavit
<br /> Home transfer through divorce,trust,or right of survivorship? Li Yes No Form 5221
<br /> BUJlf'ERINEW O,1IVNER INFOIdMATIONi(one riarv�e'par box) 1 ... .
<br /> Buyer/new owner name q,ast,first, middle): Buyer/new owner name (Last,first, middle):
<br /> . ' P 6 r0,6n, 7.47, -kl'--75-7,f4Q/
<br /> IMailing addres: i Mailing address:
<br /> iv 74 po,,J ,-s. Ct-t Loop
<br /> acA
<br /> r- s`1,; ;r, �� ,, O - q2�7 30 .
<br /> Phone number: fs -i roi3:55 Phone number:
<br /> Email address: Email address:
<br /> 3 vrv,l.j64"q\vf\ol:vlrzl)1 Cc1/v 1._
<br /> I:oyer/new owner name (Last,first, middle): .ruyer/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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