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• <br /> SECTION 6 NEW OWNER ACKNOWLEDGEMENT(One name per box) <br /> Q Person ❑Business ❑Trust E Guardian <br /> Legal Name:Patrick A. Mosher Phone:503-887-6997 <br /> ex (last, rst,middle) <br /> LU Mailing Address:4822 SW Shattuck Rd. <br /> City:Portland State:Or ZIP:97221 _ . <br /> • 0 Email:pmosher@papemachinery.com <br /> uui Right of 0Yes ❑No <br /> Z Survivorship: /� curl() <br /> - fy n Il �i01 <br /> Signature: K ( I! !lit(� , Jive Date: �I J/Q/ 2 2),� f <br /> • <br /> 0 Person ❑Business Trust `� 0 Guuardian <br /> ` Legal Name: <br /> (last,first,middle) Phone: <br /> 'III . Mailing Address: <br /> City State: ZIP: ' <br /> ® Email: <br /> W Right of ❑Yes 0 No <br /> Survivorship: <br /> Signature: Date: <br /> 0 Person ❑Business ❑Trust ❑Guardian <br /> M Legal Name: <br /> (last,first,middle) Phone: <br /> " Mailing Address: <br /> City: State: ZIP: <br /> 0 <br /> Email: <br /> LU Right of ❑Yes ❑No • <br /> Z. Survivorship: <br /> Signature: Date: <br /> 0 Person 0 Business ❑Trust ❑Guardian <br /> I: Legal Name: Phone: <br /> (last,first,middle) <br /> •� Mailing Address: <br /> �$ City: State: ZIP: <br /> 99 Email: <br /> W Right of ❑Yes ❑No <br /> z • Survivorship: <br /> li <br /> • <br /> Signature: Date: <br /> • NEW OWNER ACKNOWLEDGEMENT OF SALE/CHANGE OF OWNERSHIP <br /> I affirm that the information provided herein accurately reflects the ownership of the structure at the completion of the sale or change <br /> of ownership.1 understand that the home cannot be relocated without first completing this application and purchasing a trip permit <br /> from the Building Codes Division or through one of its county agents. <br /> I understand that the seller/owner is responsible for submitting this application within 30 days after the close of the sale,and that all <br /> buyers and sellers will be notified by mail when the application is approved.if the application has not been submitted after 30 days,I <br /> may complete the filing under ORS 446.64(1). <br /> I understand that each lessor,mortgagee,trust-deed beneficiary,lien holder of record,and security interest holder must be listed on <br /> this notice.If none are listed,the structure must be free and clear of all mortgages,deeds of trust,security interests,and liens.. <br /> Page 3 <br />