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NIL <br /> • <br /> CURRENT LOCATION INFORMATION (including city,state,ZIP) <br /> Current location: --rk � �/ L <br /> 15-15- ��W Gt' ( &tektuk_ teEL` County: <br /> El Dealer lot Dealer name: Dealer license number <br /> ❑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: a /7i' a u<) c-- nC�'ZU 77 County: <br /> ❑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: Q fl at. i C I-I 11 016 0!'7 <br /> o <br /> Are you changing the name of an existing owner? D Yes ❑ No <br /> Changing from: to: <br /> Home transfer by inheritance? ❑ Yes ] No If yes,attach appropriate Inheritance Affidavit(Form 2946 or 51 7) <br /> Home transfer due to foreclosure? ❑ Yes Q No If yes,attach Affidavit of Repossession(Form 3926) <br /> Home transfer through abandonment process? ❑ Yes U No If yes,attach Abandonment Affidavit(Form 2951) <br /> Home transfer through divorce, trust,or right of survivorship? ❑Yes 0 No If yes, attach Change Affidavit <br /> (Form 5221) <br /> BUYER/NEW OWNER INFORMATION (one name per box) <br /> i Buyer/new owner name (Last,first middle): Buyer/new owner name(Last,first, middle): <br /> I )c .I <br /> 11 ai1ivg address: / Mailing address: <br /> !3-6 Ga_Fry <br /> 1 cuu-r- 2 <br /> Phone number:SOS-7 9,_c?5 3 9 ' Phone number: <br /> Email address: Q vJ C ,C—ie.. j% Email address: <br /> Gvos/4- <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 ❑Same as above <br /> Phone number: Phone number: <br /> Email address: Email address: <br /> 440-2952(7/17/COM) Page 3 <br /> £'d 66Z�-OOZ-£09 eoiMeg ewoH a�igoW s6no4 c1017:CO co deS <br />