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1 1360135 CURRENT LOCATION INFORMATION(including city,state,ZIP) Current location: )y-fg e e o./ f a„i it ij L' ,k., q73).4 County: 0 Dealer lot Dealer name: Dealer license number: 0 Park name(if applicable): Out-of-state/federal or tribal property location: IF BEING MOVED, LOCATION CHANGES (including city,state,ZIP) New location: -,c0,7 LJ 11‘ 64-5e_-0,,mr 67739 County: , 0 Dealer lot Dealer name: `vn Dealer license number: 0 Park name(if applicable): Out-of-state/federal or tribal property location: OWNER Current owner names: C 0 4>1 C 1 jcAna 2 Are you changing the name of an existing owner? 0 Yes No Changing from: to: Home transfer by inheritance? Ei Yes R o If yes,attach appropriate Inheritance Affidavit(Form 2946 or 5177) Home transfer due to foreclosure? 0 Yes o Ifes attach Affidavit of Repossession y ' p (Form 3926) , Home transfer through abandonment process? 0 Yes / o If yes,attach Abandonment Affidavit(Form 2951) Home transfer,through divorce,trust,or right of survivorship? 0 Yes . If yes,attach Change Affidavit (Form 5221) BUYER/NEW OWNER INFORMATION(one name per box) Buyer/new owner name(Last,first, middle):I Buyer/new owner name Brinlee Mildred (Last,first,middle): 2 Mailing address: Vi Y% 34 u(n - Mailing address: Phone number: 5-4//- 6/0.,dj/i( Phone number: Email address: Email address: Buyer/new owner name(Last,first, middle): Buyer/new owner name(Last,first,middle): Mailing address: Mailing address: []Same as above 0 Same as above Phone number: Phone number: Email address: Email address: 440-2952(7/19/COM) OR Title Application-10/2019-TitleAppi 1211 Page 3 004233606-00001