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1349979 <br /> CURRENT LOCATION INFORMATION(Including city,state,ZIP) <br /> Current location: 021./115 c-;W °e i c cites 12,! V to A-I Lt,(-‘,4 d '174County: J; t�I <br /> 0 Dealer lot Dealer name: G I c, .or` 11-00- c Dealer license number: kis-ss 76 <br /> 0 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: j 12 I LI k-ca lto p ju,r‘t, KE + 4or d€,:County: ( ri- <br /> 0 Dealer lot Dealer name: - Dealer license number: <br /> 0 Park name(if applicable): <br /> Out-of-state/federal or tribal property location: <br /> OWNER <br /> Current owner names: <br /> Are you changing the name of an existing owner? 0 Yes allo <br /> Changing from: to: <br /> Home transfer by inheritance? []Yes FINo /If yes,attach appropriate Inheritance Affidavit(Form 2946 or 5177) <br /> Home transfer due to foreclosure? 0 Yes Q No If yes9t6rch Affidavit of Repossession(Form 3926) <br /> Home transfer through abandonment process? 0 Yes/[1No If yes,attach/Abandonment Affidavit(Form 2951) <br /> Home transfer through divorce,trust,or right of survivorship? ❑Yes,ENo If yes,attach Change Affidavit <br /> (Form 5221) <br /> BUYERINEW OWNER INFORMATION (one name per box) <br /> B ye /ner ame(Lash first,middle): Buyer/new owner <br /> n,a,me Las,t <br /> ,f iddle):�Ga , ? Ch,-;6-1;Mailing s: <br /> Mailing address: <br /> 1 P. a, �S ta2-1-776>3 2 , P 0. e614 3 , o2- h JP3 <br /> Phone number: (51/3)� "' 1 ?S3 Phone number:)s'j -44- <br /> Email address: Email address: Gbtotllttr2alnt-e-404 <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 C]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-TitleAppi 1211 Page 3 004186466-00001 <br />