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1642679 <br /> SECTION.6 <br /> NEW.OWNER ACKNOWLEDGEMENT(One Barrie per box) <br /> r. <br /> giPerson E Business c Trust E Guardian <br /> rd , Legal Name: KingAllan <br /> Lu (las4 first,middle) Phone:So <br /> 43I ta0� <br /> TZ Mailing Address: q 2`5 +f S aAve.. S <br /> !1 <br /> City: .ca(a r.,, State: 0 Z ZIP: <br /> Email: I�,'^9 A IlA&\5iv14i.l • Gon., <br /> Right of r yes No Survivorship: n <br /> Signature. I <br /> Date:I ( (Zzl (-3 <br /> !V,. Person Business C E Trust E Guardian <br /> Legal Name: Phone: <br /> {1U (last,first,middle) <br /> • Mailing Address: I i 11 - <br /> ® City: „t State: ZIP: <br /> Email: ' <br /> Right of r Yes r No <br /> z Survivorship: <br /> Signature: Date: <br /> r Person r Business r Trust ("`Guardian <br /> I, Legal Name: <br /> III (last,first,middle) Phone: <br /> Ai Mailing Address: <br /> f - - City: State: ZIP: <br /> Email: <br /> Right of <br /> L61°< Survivorship: r Yes n No <br /> Signature: Date: <br /> d,, r GuardianPerson r Business r Trust r <br /> t''IX Legal Name: <br /> W',. (last,first,middle) . Phone: <br /> Mailing Address: ' <br /> City: j., State: <br /> ® Email: .. <br /> It ZIP: <br /> W Right of I'r yes r No <br /> i:Z Survivorship: <br /> Signature: Date: ` <br /> NEW OWNER ACKNOWLEDGEMENT OF SALE/CHANG <br /> E OF OWNERSHIP <br /> I affirm that the information provided herein accurately reflects the ownership of the structure at the completion of the sale or <br /> change of ownership.I understand that the home cannot be relocated without first completing this application and purchasing a trip. 1 <br /> permit 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, <br /> I 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 /> 440-2952(1 I/22/BCD) Page e 3 <br /> OR Title Application-7/2023-TitloApp11211 004823449-00001 <br /> 1 <br /> I. 1 <br />