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CURRENT LOCATION INFORMATION (including city, state,ZIP) <br /> Current location: q �'�c r-�,� s fe4 0-429 7J7‘ County: <br /> 0 Dealer lot Dealer name: I Dealer license number: <br /> i ❑Park name (if applicable): <br /> IOut-of-state/federal or tribal property location: <br /> IF BEING MOVED, LOCATION CHANGES (including city, state, ZIP) <br /> New location:c77 jcj n 4...A...30U g'7L177 County: e-ic,-T(... <br /> , ❑Dealer lot Dealer name: S if) 31 -7 N Pay., L 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 /> Qene�c� c�,r,�1 v i r�i�► y C-t re] net' "—rfu_s <br /> Are you changing the name of an existing owner? Q Yes ❑ No <br /> Changing from: to: <br /> Home transfer by inheritance? ❑ Yes 1 No If yes, a tach appropriate Inheritance Affidavit(Form 2946 or 5177) 1 <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 0 No If yes,attach Abandonment Affidavit(Form 2951) <br /> If ves <br /> Home transfer through divorce,trust,or right of survivorship? ❑Yes Q No Form <br /> (Formattach Change Affidavit <br /> ( 5221) <br /> BUYER/NEW OWNER INFORMATION (one name per box) <br /> ' Buyer/new owner name (Last,first, middle): f Buyer/new owner name (Last,first, middle): <br /> Mailing address: <br /> ZG q Fry ,(/- Mailing address: <br /> 1 tri <br /> Gwt'Ot -)0 R_ 70c)2 2 <br /> Phone number:,5--e)3-7q4 3-yq Phone number: <br /> Email address: Csuu--l-torL Email address: <br /> GL.C, Lepv(1_ <br /> Buyer/new owner name(Last,first, middle): Buyer/new owner name(Last,first, middle): <br /> 1 f <br /> Mailing address: Mailing address: <br /> 3 4 <br /> D Same as above ❑ Same as above <br /> Phone number: Phone number: <br /> Email address: f Email address: <br /> 440-2952(7/17/COM) Page 3 <br /> £'d 66Z L-OOZ-£09 eoimeg ewoH engoA s6noa dLZ:t70'6I ZO Inf <br />