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<br /> 1326001
<br /> CURRENT LOCATION INFORMATION(Including city,state,ZIP)
<br /> Current location: Z1411t"J1- C gW VA S,�v. 1 -A 1 i�p i �,�/_ County: E.,i el!,1
<br /> ElDealer lot Dealer name: Dealer license number:
<br /> fl 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: /.2s /Wfi., ev/ ,e eh (,. v..,_.46,,. az v js-2- County: AA11 1 6V1
<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: -
<br /> ..-
<br /> Are
<br /> Are you changing the name of an existing owner? []YesNo
<br /> „K
<br /> Changing from: _ `�, to:
<br /> Home transfer by inheritance? fl Yes,, ` Nof yes,attach appropriate Inheritance Affidavit(Form 2946 or 5177)
<br /> Home transfer due to foreclosure? 0 Yes No If yes,
<br /> ,_attach Affidavit of Repossession(Form 3926)
<br /> Home transfer through abandonment process? 0 Yes*o No If yes,attach bandonment Affidavit(Form 2951)
<br /> Home transfer through divorce,trust,or right of survivorship? []Yes "I4o If yes,attach Change Affidavit
<br /> (Form 5221)
<br /> BUYER/NEW OWNER INFORMATION (onename per box)
<br /> Buyer/new owner name(Last,first, middle): B er/nevy o er n}:me(Last,first,middle):
<br /> Pi l t,)10,x',7719 M,+s c Ate- `.�r A[171- _ C,)t S A--A.) A $17.
<br /> Mailing address: r Mailing address:
<br /> 1 .„ - ).2..s oS '��;,,,NCr.4.4$ /- cez 1).-soa %,uw,-- (eee,/,‘ )-ki, Se
<br /> Phone number: j?_S-(e-co rf OA Ci'7 3 CZ-- Phone number:503_ 3 62-70(0 „`e eJs J ofe
<br /> 5-.23-5v9-434'd'y 913-2-
<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 /> ❑Same as above D Same as above
<br /> Phone number: Phone number:
<br /> Email address: Email address:
<br /> 440-2952(7/17/COM)
<br /> OR Title Application-10/2018-TitleAppl I211 Page 3 004152393-00001
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