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CURRENT LOCATION INFORMATION, (including city,:state, ZIP) Current location: /0 9 , 3 I� / fiver I?I.1`�E/ ( e(fQ c,a 2- 910a-67 County: RIlZy'('a ,n ❑Dealer lot Dealer name: Dealer license number: ❑Park name(if applicable): T c '0, Pel-47 Out-of-state/federal or tribal property location: IF BEING:MOVED, LOCATION CHANGES (including city, state, ZIP). New location: / 3 7/a. i,rer g d , Vie, 6e rvcos,0 2 4 70?-4 Coun tY: DA' ❑Dealer lot Dealer name: Dealer license number: ❑Park name(if applicable): (' f 1\1 n, _� li 4-1 Out-of-state/federal or tribal property location: OWNER Current owner names: G-b rdo-n Z-l'e_I' lr s Are you changing the name of an existing owner? 0 Yes ❑No NI-16m 'q �f'e,r-{-i,�-a G��p cca, pp � // M I GCS Changing from:6_0 rchi1 2 e 1 Jl SI,.L 1� to: 'rvn evt'e?i l f d n G- u e va rc� Home transfer by inheritance? ❑ Yes` No If yes,attach appropriate Inheritance Affidavit(Form 2946 or 5177) Home transfer due to foreclosure? ❑Yes XI No If yes,attach Affidavit of Repossession(Form 3926) Home transfer through abandonment process? ❑YesX No If yes,attach Abandonment Affidavit(Form 2951) Home transfer through divorce,trust,or right of survivorship? ❑YesX No If yes, attach Change Affidavit (Form 5221) BUYER/NEW OWNER INFORMATION (one name per box):. Buyer/new owner name (Last,first, middle): Buyer/new owner name,(Last,first, middle): G-untar4, YerM.e'le i d 0 uevavq 6 s,r11 ��cI \Jev -k rc Mailing address: Mailing address: , 13719, g 1 v,e'r dol- L- f 37f I_ oto r /L-c( e- 1 G f c\ra. $ , d (L— q 7 Den. 2 9 7 O 3-b Phone number: Phone number: 5b3- ,s0 7 --3/ 33 61) 3 -- 9 g 3 -- D 9 Email address: Email address: Buyer/new owner name (Last,first, middle): Buyer/new owner name(Last,first, middle): Mailing address: Mailing address: 3 4 ❑ Same as above ❑ Same as above Phone number: Phone number: Email address: Email address: 440-2952(7/19/COM) Page 3