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CURRENT LOCATION INFORMATION(including city,state,ZIP) <br /> Current location: C1 z(oL, periti�' RdJ 012., !)7cd 7 g' County: ( v e. <br /> ❑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: 9974 Gorelub Rol."9' I3 S t 1 0� Q7583 County:Mari oh <br /> ❑Dealer lot Dealer name:A \Nals McgottfacAultd fern es Dealer license number:M$D S1 f G <br /> ❑Park name(if applicable): ®ax ,. <br /> Out-of-state/federal or tribal property location: <br /> OWNER <br /> Current owner names: <br /> %Cki <br /> 'David Lk&sseX <br /> Are you changing the name of an existing owner? 0 Yes 0 No <br /> Changing from: to: talett,3 <br /> Home transfer by inheritance? 0 Yes ❑No If yes,attach appropriate Inheritance Affidavit(Form 2946 or 5177) <br /> Home transfer due to foreclosure? ❑Yes 0 No If yes,attach Affidavit of Repossession(Form 3926) <br /> Home transfer through abandonment process? 0 Yes ❑No If yes,attach Abandonment Affidavit(Form 2951) <br /> Home transfer through divorce,trust,or right of survivorship? ❑Yes ❑No If yes(Form,a5221)ttach Change Affidavit <br /> BUYER/NEW OWNER INFORMATION(one name per box) <br /> Buyer/new owner name(Las!,first,middle): Buyer/new owner name(Last,first,middle): <br /> ►ey , ,n,. <br /> Ma'i ad r�: � Mailing address: <br /> 1 Io !1S1�►i�tc.Oak <br /> rd►epenaeACti OR 91351 2 <br /> Phone number91`.Log .S- -� Phone number: <br /> Email address: Email address: <br /> Buyer/new owner name(Last,first,middle): Buyer/new owner name(Last,first,middle): <br /> 515l01 , �n>1 M. <br /> Mailing address:1,61,5 Whiff pA,K Mailing address: <br /> 3 'thdke. l O . 41351 4 <br /> 0 Same as above ❑Same as above <br /> Phone number: c 1 i f 2O —5s„`. Phone number. <br /> Email address: 1 Email address: <br /> 440-2952(7/19/COM) Page 3 — <br />