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SECTION 6 NEW.OWNER ACKNOWLEDGEMENT(One name per box) • ❑■ Person ❑Business ❑Trust ❑Guardian Legal Name: aast,first,mrddre)Van Loon, Jeremy Phone:503-580-7772 = Mailing Address: 13471 Jefferson Hwy 99E SE 1 _ • City:Jefferson State:OR ZIP 97352 -. Email:jtvanloon12@gmaii.com W Right of 0 yes ❑No Survivorship: Signature: Date: .. . - 0 Person ❑Business ❑Trust ❑Guardian... - N Legal Name: { (last,fast,middle)Van Loon, Terri Phone:541-979-8313 oc Mailing Address 13471 Jefferson Hwy 99E SE city::Jefferson State:OR ZIP:97352:, Email: UJ Right of ❑' Yes El No g - Survivorship: Signature: Date: _ ❑Person ❑Business ❑Trust •Cl Guardian Legal Name: Phone: (last,first,middle) Mailing Address:.. City:. - State: ZIP: Email: Right of Z Survivorship: ❑Yes ❑No Signature:... Date: ; ❑Person ❑Business ❑Trust ❑Guardian Legal Name:.... (last,first,middle) Phone: <. Mailing Address: City: State: ZIP: • Email: Right of Z r:z Survivorship: El Yes CI No Signature: Date: NEW OWNER ACKNOWLEDGEMENT OF SALE/CHANGE OF OWNERSHIP -I affirm that the information provided herein accurately reflects the ownership of the structure at the completion of the sale or change of ownership.I..understand that the home cannot be relocated without first completing this application and purchasing a trip permit from the Building Codes Division or through one of its county agents. I understand that the seller/owner is responsible for submitting this application within 30 days after the close of the sale,and that all buyers and sellers will be notified by mail when the application is approved.If the application has not been submitted after 30 days,I may complete the filing under ORS 446.64(1). ... I understand that each lessor,mortgagee,trust-deed beneficiary,lien holder of record;and security interest holder must be listed on this notice.If none are listed,the structure must be free and clear of all mortgages,deeds of trust,security interests,and liens.- • Page 3 .