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CURRENT LOCATION INFORMATION (including city, state,ZIP) .- <br /> CUrr' ent location 55vef-s•b,r p9i37 County: poll< <br /> El Dealer lot Dealer name: Dealer license number: - <br /> El 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: 4115 Clovrded-c ->r. SE -T- <br /> urn-edir,Dteli-IiYi2 County: 1\A(Le-10 vi <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 /> _ <br /> Current owner names Lrrtj D. e <br /> Are you changing the name of an existing owner? El Yes rThgo <br /> Changing from: to: <br /> Home transfer by inheritance? 0 Yes [IL- o If yes,attach appropriate Inheritance Affidavit(Form 2946 or 5177) <br /> Home transfer due to foreclosure? 0 Yes EI'No If yes,attach Affidavit of Repossession(Form 3926) <br /> Home transfer through abandonment process? 0 Yes [21No If yes,attach Abandonment Affidavit(Form 2951) <br /> If yes,attach Change Affidavit <br /> Home transfer through divorce,trust,or right of survivorship? El Yes ENo ' <br /> (Form 5221) <br /> BUYER/NEW OWNER INFORMATION (one name per box) <br /> inves-tmen4s <br /> Buyer/new owner name(Last,first, middle): Buyer/new owner name(Last,first, middle): <br /> G-C130- LLB <br /> Mailing address: Mailing address: <br /> 1,0115 I 0,414, 4 5 <br /> X 5-A4.4444 13 cd.- 2 <br /> • Phone number: Phone number: <br /> Email address: Email address: <br /> Buyer/new owner name(Last,first, middle): Buyer/new owner name(Last,first, middle): <br /> Mailing address: Mailing address: <br /> 3 4 <br /> El Same as above El Same as above <br /> Phone number Phone number: <br /> Email address: Email address: <br /> 440-2952(7/17/COM) Page 3 <br />