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1349979 <br /> CURRENT LOCATION INFORMATION(Including city,state,ZIP) <br /> Current location: 0-2 y/46 c, ci.+:ri( I voll A. Z t►'iLt 0 ' Com: f:rt Yl <br /> Ei Dealer lot Dealer name: C___14‘/'r` 1.1.o 1 Dealer license number: � 5 76 <br /> ID Park name(if applicable): <br /> Out-of-state/federal or tribal property location: <br /> IF BEING MOVED,LOCATION CHANGES(Including city,state,ZIP) <br /> New location: j I LI Jctc&tp lartt ge � �r d County: fir,., <br /> 0 Dealer lot Dealer name: Dealer license number: <br /> []Park name(if applicable): <br /> Out-of-state/federal or tribal property location: <br /> OWNER <br /> Current owner names: <br /> Are you changing the name of an existing owner? [+Yes j=rNo <br /> Changing from: to: <br /> Home transfer by inheritance? El Yes iNo if yes,attach appropriate Inheritance Affidavit(Form 2946 or 5177) <br /> Home transfer due to foreclosure? 0 Yes Q No If yes9t�ach Affidavit of Repossession(Form 3926) <br /> Home transfer through abandonment process? 0 Yes0No If yes,attach/Abandonment Affidavit(Form 2951) <br /> Home transfer through divorce,trust,or right of survivorship? ❑Ye E'No If yes,attach Change Affidavit <br /> (Form 5221) <br /> BUYER/NEW OWNER INFORMATION(one name per box). <br /> B yer/new owner ame(Las',first,middle): Buyer/new owner name(Last,first, middle): <br /> Nzu SCA,O,( CNris�'i : <br /> Mailing dress: Mailing address: <br /> 1 P+ a t 2 S iY12 ' » 3 2 Po. e�ycff3, . o/Z01-7WW? <br /> Phone number: — 1 S3 Phone number )5 16— <br /> Email address: Email address: OIN,D{,ifj lelyvbit-eAYul <br /> Buyer/new owner name(Last,first,middle): Buyer/new owner name(Last,first,middle): <br /> Mailing address: Mailing address: <br /> 3 4 <br /> 0 Same as above 0 Same as above <br /> Phone number: Phone number: <br /> Email address: ' Email address: <br /> 440-2932(7/1 MOM) <br /> OR Title Application-10/2018-TitleApp11211 Page 3 004186466-00001 <br />